Cost-effectiveness of treatment of early stage endometrial cancer

Objective. The purpose of this study was to determine the average life-year s gained and cost per life-year gained in treatment of early endometrial ca ncer. Methods. We performed a decision analysis using statistical models for surv ival after treatment for Stage I endometrial cancer. Estimates for survival probabilities without treatment, with surgery alone, and with surgery and radiation were derived from the literature. Charges and costs of treatment were estimated based on data from our institution. We calculated the averag e number of life-years gained and the cost per life-year gained of various treatment options based on these estimates. Sensitivity analyses were perfo rmed to determine the effect of uncertainty about parameter estimates on th e results derived from our model. Results. Based on the assumptions of our model, most of the life-years gain ed in treatment of early endometrial cancer are attributable to hysterectom y, with a very low associated cost. For the "average" woman with endometria l cancer, about 10 life-years are gained from hysterectomy at a cost of $10 00 per life-year gained, whereas adjuvant radiation yields on average 1 yea r of life gained at $4000 per life-year gained. Both life-years gained and cost are dramatically affected by age at diagnosis and to a lesser extent b y histologic grade and comorbid medical conditions. Conclusions. This analysis suggests that the use of hysterectomy and adjuva nt radiation in treatment of early endometrial cancer is a worthwhile use o f health care resources. More sophisticated models may help determine the c ost-effectiveness of various treatment strategies in specific subgroups of patients. (C) 1999 Academic Press.