| Cost-effectiveness analysis of computerized tomography in the routine follow-up of patients after primary treatment for Hodgkin's disease. | |
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MedLine Citation:
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PMID: 16943528 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To estimate the clinical benefits and cost effectiveness of computed tomography (CT) in the follow-up of patients with complete response (CR) after treatment for Hodgkin's disease (HD). PATIENTS AND METHODS: We developed a decision-analytic model to evaluate follow-up strategies for two hypothetical cohorts of 25-year-old patients with stage I-II or stage III-IV HD, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine-based chemotherapy with or without radiation therapy, respectively. We compared three strategies for observing asymptomatic patients after CR: routine annual CT for 10 years, annual CT for 5 years, or follow-up with non-CT modalities only. We used Markov models to calculate life expectancy, quality-adjusted life expectancy, and lifetime costs. Baseline probabilities, transition probabilities, and utilities were derived from published studies. Cost data were derived from the Medicare fee schedule and medical literature. We performed sensitivity analyses by varying baseline estimates. RESULTS: Annual CT follow-up is associated with minimal survival benefit. With adjustments for quality of life, we found a decrement in quality-adjusted life expectancy for early-stage patients followed with CT compared with non-CT modalities. Sensitivity analyses showed annual CT for 5 years becomes more effective than non-CT follow-up if the specificity of CT is 80% or more or if the disutility associated with a false-positive CT result is less than 0.01 quality-adjusted life years (QALYs). For advanced-stage patients, annual CT for 5 years is associated with a very small quality-adjusted survival gain over non-CT follow-up with an incremental cost-effectiveness ratio of 9,042,300 dollars/QALY. CONCLUSION: Our analysis suggests that routine CT should not be used in the surveillance of asymptomatic patients in CR after treatment for HD. |
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Authors:
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Beverly A Guadagnolo; Rinaa S Punglia; Karen M Kuntz; Peter M Mauch; Andrea K Ng |
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Publication Detail:
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Type: Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Journal of clinical oncology : official journal of the American Society of Clinical Oncology Volume: 24 ISSN: 1527-7755 ISO Abbreviation: J. Clin. Oncol. Publication Date: 2006 Sep |
Date Detail:
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Created Date: 2006-08-31 Completed Date: 2006-09-18 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8309333 Medline TA: J Clin Oncol Country: United States |
Other Details:
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Languages: eng Pagination: 4116-22 Citation Subset: IM |
Affiliation:
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Joint Center for Radiation Therapy/Harvard Radiation Oncology Program, Harvard School of Public Health, Harvard University, Boston, MA 02215, USA. aguadagnolo@post.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antineoplastic Combined Chemotherapy Protocols / therapeutic use* Bleomycin / administration & dosage Cost-Benefit Analysis Dacarbazine / administration & dosage Decision Support Techniques* Doxorubicin / administration & dosage Hodgkin Disease / drug therapy, economics*, pathology, radiography* Humans Life Expectancy Markov Chains Neoplasm Staging Population Surveillance / methods* Predictive Value of Tests Quality-Adjusted Life Years Sensitivity and Specificity Survival Analysis Tomography, X-Ray Computed / economics* Vinblastine / administration & dosage |
| Grant Support | |
ID/Acronym/Agency:
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5 R25 CA57711-11/CA/NCI NIH HHS |
| Chemical | |
Reg. No./Substance:
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11056-06-7/Bleomycin; 23214-92-8/Doxorubicin; 4342-03-4/Dacarbazine; 865-21-4/Vinblastine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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