J Gynecol Oncol.  2024 Sep;35(5):e61. 10.3802/jgo.2024.35.e61.

Cost-effectiveness analysis of hospital treatment volume and survival outcomes in endometrial cancer in Japan

• Machida H
• Matsuo K
• Higashi T
• Aoki D
• Enomoto T
• Okamoto A
• Katabuchi H
• Nagase S
• Mandai M
• Yaegashi N
• Yamagami W
• Mikami M

• KMID: 2564950
• DOI: http://doi.org/10.3802/jgo.2024.35.e61

Abstract

Objective
Hospital treatment volume affects survival in patients with endometrial cancer; notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan.
Methods
A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and highvolume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses.
Results
A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000 with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or lowvolume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and lowrisk groups, respectively.
Conclusion
Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.

Keyword

Endometrial Cancer; Cost-Effectiveness Analysis; Hospital; Survival; QualityAdjusted Life Years