Cost and risk benefit in the management of clinical stage II nonseminomatous testicular tumors

J. Baniel, B. J. Roth, Richard Foster, J. P. Donohue

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background. Two similarly effective treatment options exist for managing clinical low volume Stage II nonseminomatous germ cell testis tumors (NSGCT). Primary retroperitoneal lymph node dissection (RPLND) (with immediate adjuvant chemotherapy or chemotherapy at relapse) and primary chemotherapy have resulted in similar survival rates in large series. Because the chance for cure is similar with either approach, the cost and morbidity of therapy should be considered important discriminating factors in deciding which option to pursue for an individual patient. The purpose of this study was to undertake a cost/benefit and risk/benefit analysis of these two options using data and costs from the Indiana University experience. Methods. The overall direct costs for 100 patients undergoing primary RPLND were compared with the total direct costs of 100 patients receiving primary chemotherapy for low volume Stage II disease, including the costs of adjuvant chemotherapy, salvage chemotherapy in relapsing patients, and routine follow-up for a 5- year period. In addition, the two treatment options were analyzed relative to survival, late relapse, acute and chronic toxicity, (including fertility), and perioperative morbidity. Results. In this analysis, the overall 5-year costs of RPLND were significantly less than the costs of primary chemotherapy. The two options did not differ significantly in terms of survival or quality of life. Patients receiving RPLND were found to have an advantage also in terms of fertility, toxicity, and late relapse. Conclusions. Treatment decisions for patients with clinical low volume Stage II NSGCT may be based on cost/benefit and risk/benefit considerations, including relative toxicity, long term cure rate, and individual patient preference. Patient compliance with follow-up, the specific expertise of the physicians, and the availability of specialized therapeutic care ultimately may influence such decisions.

Original languageEnglish
Pages (from-to)2897-2903
Number of pages7
JournalCancer
Volume75
Issue number12
DOIs
StatePublished - 1995

Fingerprint

Testicular Neoplasms
Cost-Benefit Analysis
Lymph Node Excision
Costs and Cost Analysis
Drug Therapy
Adjuvant Chemotherapy
Recurrence
Fertility
Testis
Morbidity
Therapeutics
Cost of Illness
Survival
Patient Preference
Patient Compliance
Survival Rate
Quality of Life
Physicians

Keywords

  • complications
  • cost/benefit analysis
  • fertility
  • germ cell tumors
  • late relapse
  • risk/benefit analysis
  • testicular cancer-management

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cost and risk benefit in the management of clinical stage II nonseminomatous testicular tumors. / Baniel, J.; Roth, B. J.; Foster, Richard; Donohue, J. P.

In: Cancer, Vol. 75, No. 12, 1995, p. 2897-2903.

Research output: Contribution to journalArticle

Baniel, J. ; Roth, B. J. ; Foster, Richard ; Donohue, J. P. / Cost and risk benefit in the management of clinical stage II nonseminomatous testicular tumors. In: Cancer. 1995 ; Vol. 75, No. 12. pp. 2897-2903.
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abstract = "Background. Two similarly effective treatment options exist for managing clinical low volume Stage II nonseminomatous germ cell testis tumors (NSGCT). Primary retroperitoneal lymph node dissection (RPLND) (with immediate adjuvant chemotherapy or chemotherapy at relapse) and primary chemotherapy have resulted in similar survival rates in large series. Because the chance for cure is similar with either approach, the cost and morbidity of therapy should be considered important discriminating factors in deciding which option to pursue for an individual patient. The purpose of this study was to undertake a cost/benefit and risk/benefit analysis of these two options using data and costs from the Indiana University experience. Methods. The overall direct costs for 100 patients undergoing primary RPLND were compared with the total direct costs of 100 patients receiving primary chemotherapy for low volume Stage II disease, including the costs of adjuvant chemotherapy, salvage chemotherapy in relapsing patients, and routine follow-up for a 5- year period. In addition, the two treatment options were analyzed relative to survival, late relapse, acute and chronic toxicity, (including fertility), and perioperative morbidity. Results. In this analysis, the overall 5-year costs of RPLND were significantly less than the costs of primary chemotherapy. The two options did not differ significantly in terms of survival or quality of life. Patients receiving RPLND were found to have an advantage also in terms of fertility, toxicity, and late relapse. Conclusions. Treatment decisions for patients with clinical low volume Stage II NSGCT may be based on cost/benefit and risk/benefit considerations, including relative toxicity, long term cure rate, and individual patient preference. Patient compliance with follow-up, the specific expertise of the physicians, and the availability of specialized therapeutic care ultimately may influence such decisions.",
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