Laparotomy versus no laparotomy in the management of early-stage, favorable-prognosis Hodgkin's disease: A decision analysis

Purpose: To perform a decision analysis that compared the life expectancy a nd quality-adjusted life expectancy of early-stage, favorable-prognosis Hod gkin's disease (HD) managed with and without staging laparotomy, incorporat ing data on treatment outcomes of HD in the modern era. Methods: We constructed a decision-analytic model to compare laparotomy ver sus no laparotomy staging for a hypothetical cohort of 25-year-old patients with clinical stages I and II, favorable-prognosis HD. Markov models were used to simulate the lifetime clinical course of patients, whose prognosis depended on the true pathologic stage and initial treatment. The baseline p robability estimates used in the model were derived from results of publish ed studies. Quality-of-life adjustments for procedures and treatments, as w ell as the various long-term health states, were incorporated. Results: The life expectancy was 36.67 years for the laparotomy strategy an d 35.92 years for no laparotomy, yielding a net expected benefit of 0.75 ye ars for laparotomy staging, The corresponding quality-adjusted life expecta ncies for the two strategies were 35.97 and 35.38 quality-adjusted life yea rs (QALYs), respectively, resulting in a net expected benefit of laparotomy staging of 0.59 QALYs. Sensitivity analysis showed that the decision of la parotomy versus no laparotomy was most heavily influenced by the quality-of -life weight assigned to the postlaparotomy state. Conclusion: Our model predicted that on average, for a 25-year-old patient, proceeding with staging laparotomy resulted in a gain in life expectancy o f 9 months, or 7 quality-adjusted months, These results suggest that a role remains for surgical staging in the management of early-stage HD. J Clin Oncol 17:241-252, (C) 1999 by American Society of Clinical Oncology.