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AS04. Endometrial/Uterine corpus cancers
PR035/#95  A cost-effectiveness analysis of hospital treatment volume and survival outcomes in patients with endometrial cancer in Japan
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  1. Hiroko Machida1,
  2. Mikio Mikami1,
  3. Koji Matsuo2,
  4. Daisuke Aoki3,
  5. Takayuki Enomoto4,
  6. Aikou Okamoto5,
  7. Hidetaka Katabuchi6,
  8. Satoru Nagase7,
  9. Masaki Mandai8,
  10. Nobuo Yaegashi9 and
  11. Wataru Yamagami3
  1. 1Tokai University School of Medicine, Obstetrics and Gynecology, Isehara, Japan
  2. 2University of Southern California,, Gynecologic Oncology, Los angeles, USA
  3. 3Keio University School of Medicine, Gynecologic Oncology, Tokyo, Japan
  4. 4Niigata University School of Medicine, Gynecologic Oncology, Niigata, Japan
  5. 5Jikei University School of Medicine, Gynecologic Oncology, Minatoku, Japan
  6. 6Faculty of Life Sciences, Kumamoto University, Gynecology, Kumamoto, Japan
  7. 7Yamagata University Faculty of Medicine, Gynecologic Oncology, yamagata, Japan
  8. 8Graduate School of Medicine, Kyoto University, Gynecologic Oncology, Kyoto, Japan
  9. 9Tohoku University, Gynecologic Oncology, Sendai, Japan

Abstract

Introduction The hospital treatment volume affects survival outcomes for endometrial cancer; notably, the initial treatment at high-volume centers improved survival outcomes. We assessed the cost-effectiveness of hospital treatment volume and survival outcomes in patients with endometrial cancer.

Methods A decision-analytic model was evaluated following assessment strategies regarding the costs and effects: 1) hospital treatment volume (low-, moderate-, and high-volume centers) and 2) post-operative recurrent risk factors based on pathological findings (adjuvant therapy in high- and intermediate-risk or without adjuvant therapy in low risk). Input data were derived from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Diagnosis Procedure Combination database in Japan. Quality-adjusted life years (QALYs) were used as a measure of effectiveness. The model was built from a public healthcare perspective, and the impact of uncertainty was assessed with sensitivity analyses.

Results A base-case analysis showed that treatment at high-volume centers was the most effective strategy for patients with endometrial cancer, and the incremental cost-effectiveness ratio was below a willingness-to-pay threshold of ¥5,000,000 with a maximum of ¥3,777,830/4.28 QALY. Treatment at the high-volume centers was dominant compared to intermediate- or low-volume centers with the efficiency and cost-effectiveness. Sensitivity analyses showed that the model outcome was robust to input value changes. With a willingness-to-pay threshold of ¥5,000,000, treatment at the high-volume center remained cost-effective in at least 73.6% of iterations.

Conclusion/Implications Treatment at high-volume centers is the most cost-effective strategy to guide the need for treatment centralization in patients with endometrial cancer.

Abstract PR035/#95 Figure 1
Abstract PR035/#95 Figure 1

Decision tree representing the initial treatment pathway of EMCA

View this table:
Abstract PR035/#95 Table 1

Incremental analysis

https://doi.org/10.1136/ijgc-2023-IGCS.77

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