Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis

Greving, J. P., Vernooji, F., Heintz, A. P. M., van der Graaf, Y. & Buskens, E., Apr-2009, In : Gynecologic Oncology. 113, 1, p. 68-74 7 p.

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  • Jacoba P. Greving
  • Flora Vernooji
  • A. Peter M. Heintz
  • Yolanda van der Graaf
  • Erik Buskens

Objective. To evaluate the cost-effectiveness of tertiary referral care for ovarian cancer patients in the Netherlands.

Methods. We collected clinical and registry data on 1077 newly diagnosed ovarian cancer patients treated from 1996-2003 in a random sample of Dutch hospitals. Decision modelling was used to compare the cost-effectiveness of treatment in general hospitals, semi-specialized hospitals, and tertiary care centers. The actual direct medical costs of ovarian cancer treatment were evaluated. Long-term outcomes in terms of costs, quality-adjusted life-years (QALYs). and incremental costs per QALY gained were estimated. To assess uncertainty, multivariable sensitivity analyses and scenario analyses were performed.

Results. Treatment of ovarian cancer patients in semi-specialized hospitals costs on average (sic)882 more than in general hospitals (95% confidence interval -720 to 2462) and yields 0.12 additional QALYs (95% CI 0.02 to 0.22), resulting in an incremental cost-effectiveness ratio (ICER) of (sic)7135. Patients treated in tertiary care centers incurred again higher costs ((sic)10,591, 95% CI 8757 to 12,480) and also higher QALYs (0.10, 95% CI 0 to 0.21), resulting in an ICER of (sic)102,642 compared to semi-specialized hospitals. If the optimal debulking rate in tertiary care centers would increase to 70%, costs could drop below (sic)30,000 per QALY.

Conclusion. Current treatment of ovarian cancer patients in semi-specialized hospital settings is a cost-effective strategy, while treatment in tertiary care centers becomes only cost-effective when better surgical results would be achieved. (C) 2008 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)68-74
Number of pages7
JournalGynecologic Oncology
Issue number1
Publication statusPublished - Apr-2009


  • Centralized care, Cost-effectiveness analysis, Ovarian cancer, Quality-adjusted life-years, Hospital setting, Gynecologic oncologist, EARLY-STAGE OVARIAN, GYNECOLOGIC ONCOLOGISTS, LAPAROSCOPY, LAPAROTOMY, CARCINOMA, SURVIVAL, OUTCOMES, SURGERY

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