Decision analysis on alternative treatment strategies for favorable-prognosis, early-stage Hodgkin's disease

Purpose: To compare the therapeutic outcomes of various treatment strategie s in early-stage, favorable-prognosis Hodgkin's disease (HD) using methods of decision analysis, Methods: We constructed a decision-analytic model to determine the life exp ectancy and quality-adjusted life expectancy for a hypothetical cohort of c linically or pathologically staged 25-year-old patients with early-stage, f avorable-prognosis HD treated with varying degrees of initial therapy, Mark ov models were used to simulate the lifetime clinical course of patients, a nd baseline probability estimates were derived from published study results , Results: Among patients with pathologic stage (PS)I to II, mantle and para- aortic (MPA) radiotherapy was favored over combined-modality therapy (CMT), mantle radiotherapy, and chemotherapy by 1.18, 1.33, and 1.55 years, respe ctively. For patients with clinical stage (CS) I to II, the treatment optio ns of MPA-splenic radiotherapy, CMT, and chemotherapy yielded similar survi val outcomes, Sensitivity analysis showed that the decision between CMT and MPA-splenic radiotherapy was highly influenced by the precise values of th e estimates of treatment efficacy and long-term morbidity, the quality-of-l ife value assigned to the postsplenic irradiation state, and the time disco unt value used in the model, probabilistic sensitivity analysis demonstrate d that even it future studies doubled the precision of the estimates of the treatment-related variables, it would be impossible to demonstrate the sup eriority of one treatment over the other, Conclusion: Our model predicted that on average, MPA radiotherapy was clear ly the preferred treatment for PS I to II patients. For CS I to It patients the treatment decision is a toss-up between MPA-splenic radiotherapy and C MT, emphasizing the importance of patient preference exploration and shared decision making between patient and physician when choosing between treatm ents. (C) 1999 by American Society of Clinical Oncology.