Cost-effectiveness analysis of hospital treatment volume and survival outcomes in endometrial cancer in Japan
- Author:
Hiroko MACHIDA
1
;
Koji MATSUO
;
Takahiro HIGASHI
;
Daisuke AOKI
;
Takayuki ENOMOTO
;
Aikou OKAMOTO
;
Hidetaka KATABUCHI
;
Satoru NAGASE
;
Masaki MANDAI
;
Nobuo YAEGASHI
;
Wataru YAMAGAMI
;
Mikio MIKAMI
Author Information
- Publication Type:Original Article
- From:Journal of Gynecologic Oncology 2024;35(5):e61-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:Hospital treatment volume affects survival in patients with endometrial cancer;notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan.
Methods:A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and highvolume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses.
Results:A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or lowvolume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and lowrisk groups, respectively.
Conclusion:Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.
