Introduction/Background SHAPE was an international Phase III trial comparing radical hysterectomy to simple hysterectomy for early-stage cervical cancer. Simple hysterectomy was non-inferior to radical hysterectomy with respect to pelvic recurrence rate at 3 years, but superior in terms of postoperative complications, quality of life, and sexual health. Our objective was to conduct a cost-effectiveness analysis comparing the two treatment strategies.

Methodology A Markov model compared the costs in 2023 Canadian dollars and benefits of simple hysterectomy versus radical hysterectomy (both with lymph node assessment). The model was informed by empirical data from SHAPE, and costs from national and provincial sources. Health utilities were derived from EQ-5D-5L surveys conducted in Canada, United Kingdom, France, and Ireland. Effectiveness was measured in quality-adjusted life years (QALYs). Sensitivity analyses accounted for uncertainty around various parameters. Time horizon was 5 years. Monte Carlo simulation estimated the number of patients in various scenarios experiencing different complications.

Results Simple hysterectomy was more effective and less costly than radical hysterectomy. Average lifetime costs were $20,044 and $21,714, and average gains were 3.55 and 3.53 QALYs for simple and radical hysterectomy, respectively. Baseline health utility scores were 0.81 and 0.83 for simple and radical hysterectomy, respectively. These scores exceeded baseline for simple hysterectomy (0.82) but never recovered to baseline by year 3 for radical hysterectomy (0.82). Assuming 800 patients with early cervical cancer in Canada annually, we estimated 3 versus 82 patients with urinary retention, and 49 versus 88 patients with urinary incontinence persisting 4 weeks after simple versus radical hysterectomy, respectively. Results were most sensitive to variability in health utilities associated with surgery, but stable through wide ranges of costs and recurrence estimates.

Conclusion Simple hysterectomy with lymph node assessment is less costly and more effective in terms of quality adjusted life expectancy compared to radical hysterectomy for early-stage cervical cancer.

Disclosures None.