Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program

Our plain-English summary of Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program, by T.C. Chua, S. Martin, A. Saxena, et al (Annals of Surgery, 2010).

The study

• Authors: T.C. Chua, S. Martin, A. Saxena, W. Liauw, T.D. Yan, J. Zhao, I. Lok, D.L. Morris
• Journal: Annals of Surgery
• Published: 2010;251(2):323-9
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment approaches for peritoneal carcinomatosis that has demonstrated improved survival outcomes with acceptable complication rates. This report aims to measure and describe the survival outcomes and health care cost associated with CRS and HIPEC for peritoneal surface malignancies at a centralized tertiary institution in Australia.

Methods: The expenditure of treatment for 136 consecutive patients who underwent 159 CRS and HIPEC from June 2002 to June 2008 were obtained. Together with their survival outcomes from treatment, a cost-effectiveness analysis was performed.

Results: The average cost of CRS and HIPEC per patient and per life year for appendix cancer is AUD $88,423 (range, AUD $23,933-AUD $299,145) and AUD $37,737/LY; for colorectal cancer is AUD $66,148 (range, AUD $26,079-AUD $409,666) and AUD $29,757/LY; for pseudomyxoma peritonei is AUD $92,308 (range, AUD $11,562-AUD $501,144) and AUD $29,559/LY; for peritoneal mesothelioma is AUD $55,062 (range, AUD $23,261-AUD $94,104) and AUD $20,521/LY; and for other peritoneal surface malignancies is AUD $44,668 (range, AUD $31,592-AUD $70,026) and AUD $22,091/LY.

Conclusions: This complex surgical treatment results in significant increases in medical costs with a parallel increase in survival for a disease that has been poorly treated, and hence may be considered as cost-effective given the observed life years gained.

In plain English

This study from St George Hospital in Sydney, Australia, examined costs and survival for 136 consecutive patients whose cancer had spread over the abdominal lining (peritoneal surface malignancy). Between June 2002 and June 2008 they had 159 operations combining extensive tumor-removal surgery with heated chemotherapy inside the abdomen (CRS and HIPEC). Fifteen patients had peritoneal mesothelioma. The article does not discuss asbestos. Across all patients, median survival was 65 months, and 76 (48%) of the procedures led to major complications. The average cost per procedure was AUD $66,456. In the peritoneal mesothelioma group, median survival was 49 months, the average cost per patient was AUD $55,062 (range AUD $23,261 to AUD $94,104), and the cost per life year was AUD $20,521. A comparison with standard treatment was possible only for colorectal cancer, giving about AUD $21,290 per life year saved. The authors concluded the treatment may be considered cost-effective. They noted possible selection bias and that patients' own costs, such as transport and carers, were not counted.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-centre cost-effectiveness analysis of consecutive patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, using a prospective database and hospital costing data
• Who was studied: 136 consecutive patients (59 men, 77 women; mean age 52) with peritoneal surface malignancy who underwent 159 procedures at St George Hospital, Sydney, Australia, June 2002 to June 2008: 59 pseudomyxoma peritonei, 17 appendix adenocarcinoma, 34 colorectal adenocarcinoma, 15 peritoneal mesothelioma, 11 other
• Exposure: Not an asbestos exposure study. The 'exposure' is the treatment: cytoreductive surgery followed by heated intraperitoneal chemotherapy at about 42°C for 90 minutes. Peritoneal mesothelioma and ovarian cancers received cisplatin and doxorubicin; gastrointestinal cancers received mitomycin C. Some patients also received early postoperative intraperitoneal chemotherapy.
• Main results:
  • All 136 patients: median follow-up 30 months, overall median survival 65 months, and 1-, 3- and 5-year survival rates of 92%, 68% and 52%
  • Peritoneal mesothelioma patients (15): median survival 49 months
  • Peritoneal mesothelioma patients: average cost per patient AUD $55,062 (range AUD $23,261 to AUD $94,104), and AUD $20,521 per life year
  • Of the 159 procedures, 76 (48%) resulted in major (Grade III/IV) complications. There was one death within 30 days of treatment.
  • Average cost per procedure over the 6 financial years was AUD $66,456
  • Cost per life year by cancer type: AUD $37,737 appendix cancer, AUD $29,757 colorectal cancer, AUD $29,559 pseudomyxoma peritonei (text figure), AUD $20,521 peritoneal mesothelioma, AUD $22,091 other
  • Colorectal cancer only: compared with standard treatment (estimated at AUD $18,246 and about 6 months survival), the incremental cost was AUD $47,902 for 27 months of survival gained, estimated at AUD $21,290 per life year saved
• The authors' conclusion: The authors concluded that the treatment substantially increases medical costs but brings a parallel increase in survival, and so may be considered cost-effective given the life years gained
• Limitations the authors state:
  • Possible selection bias. Survival gains in colorectal cancer may partly reflect modern systemic chemotherapy.
  • Costs borne by patients (transportation, meals, carers) were not included
  • Costs of patients found unsuitable at exploratory laparotomy were not included (estimated at under 5%)
  • Standard-treatment cost estimates were available only for colorectal cancer
  • The analysis used only one outcome measure, life-years gained

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Colorectal Cancer, Peritoneal Mesothelioma.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: long-term results at St George Hospital, Australia — N. Alzahrani, J.S. Ferguson, et al. (2016)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)

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