Modeling the cost of management options for stage I nonseminomatous germ cell tumors: A decision tree analysis

Richard E. Link, Mohamad E. Allaf, Roberto Pili, Louis R. Kavoussi

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: Patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) have been managed with surveillance, chemotherapy, or retroperitoneal lymphadenectomy (RPLND) with similar survival outcomes. Cost factors influencing the choice of therapy were evaluated using computer-based decision analysis. Methods: A detailed model was developed that integrates projected costs for more than 60 possible treatment outcomes. It incorporates primary, adjuvant, and salvage chemotherapy, primary and postchemotherapy RPLND, and both laparoscopic and open surgical approaches. Starting values and probabilities were derived from a comprehensive meta-analysis of the last 25 years of testes cancer literature. Hypothesis testing was performed using sensitivity analysis. Results: The model predicts a cost premium for both primary chemotherapy (18.7%) and RPLND (51.7%) compared with surveillance. If laparoscopic RPLND was practiced, the cost premium for primary surgery (29.1%) approached that of chemotherapy (26.4%). Open RPLND was 1.25x as costly as laparoscopic RPLND, primarily because of longer hospitalization. The choice of open RPLND yielded a 6.9% cost premium for a surveillance program in this model. For such a program, primary chemotherapy became cost advantageous when the probability of recurrence during surveillance was more than 46%. Conclusion: This model allows a variety of treatment cost hypotheses to be tested. Primary RPLND is never cost advantageous over surveillance or primary chemotherapy. Surgical costs can significantly increase the overall cost of a surveillance program. In stage I patients with high-risk tumor characteristics, primary chemotherapy may have a cost advantage over surveillance.

Original languageEnglish (US)
Pages (from-to)5762-5773
Number of pages12
JournalJournal of Clinical Oncology
Volume23
Issue number24
DOIs
StatePublished - 2005
Externally publishedYes

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Decision Trees
Decision Support Techniques
Costs and Cost Analysis
Drug Therapy
Nonseminomatous germ cell tumor
Testicular Neoplasms
Adjuvant Chemotherapy
Lymph Node Excision
Health Care Costs
Meta-Analysis
Hospitalization
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Modeling the cost of management options for stage I nonseminomatous germ cell tumors : A decision tree analysis. / Link, Richard E.; Allaf, Mohamad E.; Pili, Roberto; Kavoussi, Louis R.

In: Journal of Clinical Oncology, Vol. 23, No. 24, 2005, p. 5762-5773.

Research output: Contribution to journalArticle

Link, Richard E. ; Allaf, Mohamad E. ; Pili, Roberto ; Kavoussi, Louis R. / Modeling the cost of management options for stage I nonseminomatous germ cell tumors : A decision tree analysis. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 24. pp. 5762-5773.
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abstract = "Purpose: Patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) have been managed with surveillance, chemotherapy, or retroperitoneal lymphadenectomy (RPLND) with similar survival outcomes. Cost factors influencing the choice of therapy were evaluated using computer-based decision analysis. Methods: A detailed model was developed that integrates projected costs for more than 60 possible treatment outcomes. It incorporates primary, adjuvant, and salvage chemotherapy, primary and postchemotherapy RPLND, and both laparoscopic and open surgical approaches. Starting values and probabilities were derived from a comprehensive meta-analysis of the last 25 years of testes cancer literature. Hypothesis testing was performed using sensitivity analysis. Results: The model predicts a cost premium for both primary chemotherapy (18.7{\%}) and RPLND (51.7{\%}) compared with surveillance. If laparoscopic RPLND was practiced, the cost premium for primary surgery (29.1{\%}) approached that of chemotherapy (26.4{\%}). Open RPLND was 1.25x as costly as laparoscopic RPLND, primarily because of longer hospitalization. The choice of open RPLND yielded a 6.9{\%} cost premium for a surveillance program in this model. For such a program, primary chemotherapy became cost advantageous when the probability of recurrence during surveillance was more than 46{\%}. Conclusion: This model allows a variety of treatment cost hypotheses to be tested. Primary RPLND is never cost advantageous over surveillance or primary chemotherapy. Surgical costs can significantly increase the overall cost of a surveillance program. In stage I patients with high-risk tumor characteristics, primary chemotherapy may have a cost advantage over surveillance.",
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