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- W4246151102 abstract "4525 Background: Survival rates for good risk clinical stage I NGSCT exceed 98%. Although long term outcomes for surveillance (SURV) and primary retroperitoneal lymph node dissection (RPLND) may be equivalent, their relative cost-effectiveness is unknown. Approximately 30% on SURV will relapse and will be treated with chemotherapy (CHEMO) +/- RPLND. We present a pilot study to model the cost effectiveness of SURV vs RPLND. Methods: Patients in 4 health states (>1 year post treatment) were evaluated: a) SURV b) RPLND c) CHEMO or d) RPLND and CHEMO. Utilities were collected using the EuroQol, Time Trade Off (TTO), Standard Gamble (SG) and Visual Analog Scale (VAS). Direct medical costs (DMC) were determined using the 2002 Medicare Fee Schedule. Costas and benefits were discounted 3% annually. Health care resource use was determined using National Comprehensive Cancer Network guidelines. Paients were assumed to have only one relapse and late relapses (more than 3 years) were considered equal in both groups. Quality Adjusted Life Years (QALY) =utility*life years. Cost effective ratio (C/E)=DMC/QALY. Decision analysis was modeled using a Markov process for a 25 year old man and tested using standard and probabilistic sensitivity analysis. Results: Mean utilities are listed in the table below. Total costs for RPLND:$48,372, SURV:$62,598(primarily due to increased diagnostic tests during SURV period). QALY were 23.33 and 24.77 respectively. The incremental C/E for surveillance was $9,870 per QALY, suggesting that SURV is cost effective. Conclusion: Though limited by the small sample size and the disproportionately few patients on SURV alone, this pilot study shows that this is a feasible model for determining cost-effectiveness. This will be used as a model for a future, larger study to further clarify this issue and guide clinicians in making treatment recommendations. No significant financial relationships to disclose." @default.
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- W4246151102 date "2004-07-15" @default.
- W4246151102 modified "2023-10-16" @default.
- W4246151102 title "Modeling the cost-effectiveness of treatment options for patients with clinical stage I non seminomatous germ cell tumors (NGSCT)" @default.
- W4246151102 doi "https://doi.org/10.1200/jco.2004.22.14_suppl.4525" @default.
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