Costs and effectiveness of staging and treatment options in early-stage Hodgkin's disease

Purpose: Using a cost-effectiveness analysis, to weigh the costs and benefi ts of the different staging and treatment options in early-stage Hodgkin's disease. Methods: We constructed a decision-analytic model for a hypothetical cohort of 25-year-old patients with early-stage Hodgkin's disease. Markov models were used to simulate the lifetime costs and prognosis of each staging and treatment strategy. Baseline probabilities and cost estimates were derived from published studies and bills of relevant patient cohorts. Results: Among the six management strategies considered, the incremental co st-effectiveness ratio of laparotomy and tailored treatment compared with m antle and para-aortic-splenic radiation therapy in all clinical stage I-II patients was $24,100/quality-adjusted life year, while that of the strategy of combined modality therapy in all clinical stage I-II patients compared with laparotomy was $61,700/quality-adjusted life year. All the remaining s trategies were dominated by one of these three strategies. Sensitivity anal ysis showed that the cost-effectiveness ratios were driven predominantly by the effectiveness rather than the cost of each strategy. In particular, th e analysis was heavily influenced by the utility of the post-laparotomy hea lth state. Conclusions: In considering the various alternative management strategies i n early-stage Hodgkin's disease, even very small gains in effectiveness wer e enough to justify the additional costs of more expensive treatment option s. (C) 2001 Elsevier Science Inc.