A comparison of treatment strategies for endometrial adenocarcinoma: Analysis of financial impact

Objective. The aim of this study was to investigate the influence of three treatment strategies for adenocarcinoma of the endometrium on the utilizati on of adjuvant radiation therapy and the medical charges associated with ea ch pattern of practice. Methods. Three clinical algorithms felt to represent practice patterns for patients with endometrial cancer were considered: (1) comprehensive surgica l staging of all patients, with adjuvant pelvic radiation reserved for docu mented cases of extrauterine disease, (2) total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) with lymph node dissection reser ved for cases of myometrial invasion, followed by adjuvant radiation based on the presence of uterine risk factors, and (3) TAH/BSO followed by intrao perative pathologic assessment of the uterus and consultation with a "surgi cal" oncologist for comprehensive staging. Each algorithm was applied to a cohort of 190 surgically staged patients identified through a retrospective medical records review. The use of radiation in each algorithm was quantif ied and the associated financial impact was estimated using hospital charge s. Results. Treatment algorithm 1 yielded the lowest charges per patient at $1 2,778.52. Treatment algorithms 2 and 3 had associated charges per patient o f $15,997.02 and $17,343.44, respectively. Conclusion. Approaches to care that lead to cost-effective utilization of h ealth care resources should be pursued. (C) 1999 Academic Press.