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• W2116785036 abstract "Purpose/Objective(s)Testicular Seminoma is amongst the most common cancers in males age 15-35, with roughly 85% of patients diagnosed with stage I disease. Acceptable post-orchiectomy management strategies for stage I patients include surveillance, para-aortic (PA)-radiation therapy (RT), dog-leg (DL)-RT or a single cycle of carboplatin (Carbo). The required follow-up recommendations for each treatment option were recently amended by the National Comprehensive Cancer Network (NCCN) in 2012. As such, surveillance imaging after treatment, a contributor to treatment costs, was significantly scaled back.Materials/MethodsNCCN guidelines were used to design treatment plans for each of the acceptable adjuvant treatments strategies: single agent Carbo (AUC = 7), PA-RT (20 Gy), DL-RT (20 Gy) and salvage chemotherapy (Bleomycin, Etoposide and Cisplatin x 3 cycles). NCCN guidelines for growth factor support and anti-emetic use were incorporated into the treatments. Follow-up charges were also generated for 10 years based on both the 2012 (version 1.2012) and the 2011 NCCN (version 2.2011) surveillance recommendations. According to published literature, the anticipated failure rate for surveillance only, either RT adjuvant strategy, or adjuvant Carbo was 18%, 5%, and 4% respectively. The 2012 Medicare fee schedule was used to calculate the reimbursement for each treatment strategy. Cost-effectiveness analyses were performed using incremental cost effectiveness ratios (ICER) to compare treatment options.ResultsUnder the current 2012 NCCN recommendations, the total reimbursement generated over 10 years for observation, PA- RT, DL-RT, and Carbo were $10,643, $11,678, $9,662, and $10,405 respectively. This is compared to the required follow-up under the 2011 and earlier versions of the guidelines for which the costs (based on 2012 reimbursements) for the observation, PA- RT, DL-RT, and Carboplatin were $20,986, $11,517, $9,394, and $20,365 respectively. ICERs for each group were calculated using the 2012 Medicare reimbursement and 5-year Relapse Free Survival Rate. At five years, without factoring salvage therapy as defined in our model of patient outcomes, observation in the setting of the 2012 guidelines was found to be less costly than adjuvant RT or Carbo. Factoring the rates of relapse into a salvage model, observation was found to be more costly and less effective compared to PA-RT, DL-RT and Carbo ($1,831, $7,318, $7,010) in the adjuvant management of stage I seminoma patients.ConclusionsBased on ICER, PA-RT, DL-RT and Carboplatin are a cost effective option for the treatment of stage I seminoma compared to observation; however, further studies are required to validate these findings. Such cost and reimbursement analyses are becoming increasingly relevant, however, not meant to usurp sound clinical judgment. Purpose/Objective(s)Testicular Seminoma is amongst the most common cancers in males age 15-35, with roughly 85% of patients diagnosed with stage I disease. Acceptable post-orchiectomy management strategies for stage I patients include surveillance, para-aortic (PA)-radiation therapy (RT), dog-leg (DL)-RT or a single cycle of carboplatin (Carbo). The required follow-up recommendations for each treatment option were recently amended by the National Comprehensive Cancer Network (NCCN) in 2012. As such, surveillance imaging after treatment, a contributor to treatment costs, was significantly scaled back. Testicular Seminoma is amongst the most common cancers in males age 15-35, with roughly 85% of patients diagnosed with stage I disease. Acceptable post-orchiectomy management strategies for stage I patients include surveillance, para-aortic (PA)-radiation therapy (RT), dog-leg (DL)-RT or a single cycle of carboplatin (Carbo). The required follow-up recommendations for each treatment option were recently amended by the National Comprehensive Cancer Network (NCCN) in 2012. As such, surveillance imaging after treatment, a contributor to treatment costs, was significantly scaled back. Materials/MethodsNCCN guidelines were used to design treatment plans for each of the acceptable adjuvant treatments strategies: single agent Carbo (AUC = 7), PA-RT (20 Gy), DL-RT (20 Gy) and salvage chemotherapy (Bleomycin, Etoposide and Cisplatin x 3 cycles). NCCN guidelines for growth factor support and anti-emetic use were incorporated into the treatments. Follow-up charges were also generated for 10 years based on both the 2012 (version 1.2012) and the 2011 NCCN (version 2.2011) surveillance recommendations. According to published literature, the anticipated failure rate for surveillance only, either RT adjuvant strategy, or adjuvant Carbo was 18%, 5%, and 4% respectively. The 2012 Medicare fee schedule was used to calculate the reimbursement for each treatment strategy. Cost-effectiveness analyses were performed using incremental cost effectiveness ratios (ICER) to compare treatment options. NCCN guidelines were used to design treatment plans for each of the acceptable adjuvant treatments strategies: single agent Carbo (AUC = 7), PA-RT (20 Gy), DL-RT (20 Gy) and salvage chemotherapy (Bleomycin, Etoposide and Cisplatin x 3 cycles). NCCN guidelines for growth factor support and anti-emetic use were incorporated into the treatments. Follow-up charges were also generated for 10 years based on both the 2012 (version 1.2012) and the 2011 NCCN (version 2.2011) surveillance recommendations. According to published literature, the anticipated failure rate for surveillance only, either RT adjuvant strategy, or adjuvant Carbo was 18%, 5%, and 4% respectively. The 2012 Medicare fee schedule was used to calculate the reimbursement for each treatment strategy. Cost-effectiveness analyses were performed using incremental cost effectiveness ratios (ICER) to compare treatment options. ResultsUnder the current 2012 NCCN recommendations, the total reimbursement generated over 10 years for observation, PA- RT, DL-RT, and Carbo were $10,643, $11,678, $9,662, and $10,405 respectively. This is compared to the required follow-up under the 2011 and earlier versions of the guidelines for which the costs (based on 2012 reimbursements) for the observation, PA- RT, DL-RT, and Carboplatin were $20,986, $11,517, $9,394, and $20,365 respectively. ICERs for each group were calculated using the 2012 Medicare reimbursement and 5-year Relapse Free Survival Rate. At five years, without factoring salvage therapy as defined in our model of patient outcomes, observation in the setting of the 2012 guidelines was found to be less costly than adjuvant RT or Carbo. Factoring the rates of relapse into a salvage model, observation was found to be more costly and less effective compared to PA-RT, DL-RT and Carbo ($1,831, $7,318, $7,010) in the adjuvant management of stage I seminoma patients. Under the current 2012 NCCN recommendations, the total reimbursement generated over 10 years for observation, PA- RT, DL-RT, and Carbo were $10,643, $11,678, $9,662, and $10,405 respectively. This is compared to the required follow-up under the 2011 and earlier versions of the guidelines for which the costs (based on 2012 reimbursements) for the observation, PA- RT, DL-RT, and Carboplatin were $20,986, $11,517, $9,394, and $20,365 respectively. ICERs for each group were calculated using the 2012 Medicare reimbursement and 5-year Relapse Free Survival Rate. At five years, without factoring salvage therapy as defined in our model of patient outcomes, observation in the setting of the 2012 guidelines was found to be less costly than adjuvant RT or Carbo. Factoring the rates of relapse into a salvage model, observation was found to be more costly and less effective compared to PA-RT, DL-RT and Carbo ($1,831, $7,318, $7,010) in the adjuvant management of stage I seminoma patients. ConclusionsBased on ICER, PA-RT, DL-RT and Carboplatin are a cost effective option for the treatment of stage I seminoma compared to observation; however, further studies are required to validate these findings. Such cost and reimbursement analyses are becoming increasingly relevant, however, not meant to usurp sound clinical judgment. Based on ICER, PA-RT, DL-RT and Carboplatin are a cost effective option for the treatment of stage I seminoma compared to observation; however, further studies are required to validate these findings. Such cost and reimbursement analyses are becoming increasingly relevant, however, not meant to usurp sound clinical judgment." @default.
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• W2116785036 date "2013-10-01" @default.
• W2116785036 modified "2023-10-14" @default.
• W2116785036 title "Cost Analysis of Alternative Treatment Modalities Utilized in the Management of Early-Stage Testicular Seminoma" @default.
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