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Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention.

Publication ,  Journal Article
Dottino, JA; Cliby, WA; Myers, ER; Bristow, RE; Havrilesky, LJ
Published in: Gynecol Oncol
September 2015

OBJECTIVE: To estimate the potential cost-effectiveness of an intervention to improve adherence to National Comprehensive Cancer Network (NCCN) guideline-based care for ovarian cancer. METHODS: A modified Markov model with a 5-year time horizon estimated the potential cost-effectiveness of an intervention (AD-INT) to improve NCCN-guideline adherence compared to status quo (SQ) levels of adherence. Data were obtained from a population-based analysis of National Cancer Data Base records for ovarian cancer diagnosed from 1998 to 2002 (N=47,160). Cohorts were defined by race and adherence to NCCN guideline-based care. Costs were estimated using 2014 Medicare reimbursements. Incremental cost-effectiveness ratios (ICERs) were calculated in 2014 US dollars per year of life saved (YLS) using the standard threshold of $50,000/YLS. We simulated an AD-INT that reduced non-adherence by 25% and cost at least $100 per patient. One-way sensitivity analyses were performed. RESULTS: Although the individual components of guideline-adherent care are more costly than non-adherent care, a reasonably effective AD-INT is also highly likely to be cost-effective. An AD-INT costing $100 per patient and reducing non-adherence by 25% is cost-effective with an ICER of $22/YLS compared with SQ, while interventions costing over $1000 remain cost-effective, up to a per-patient intervention cost of up to $8000 (targeting only blacks) or $4000 (targeting all patients). CONCLUSIONS: An ovarian cancer intervention that moderately decreases racial disparities in NCCN guideline adherent care or improves adherence for all is potentially cost-effective. Further research may determine which modifiable factors may be targeted to help reduce adherence disparities.

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

September 2015

Volume

138

Issue

3

Start / End Page

694 / 699

Location

United States

Related Subject Headings

  • United States
  • Practice Guidelines as Topic
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Models, Economic
  • Markov Chains
  • Humans
  • Guideline Adherence
  • Female
  • Cost-Benefit Analysis
 

Citation

APA
Chicago
ICMJE
MLA
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Dottino, J. A., Cliby, W. A., Myers, E. R., Bristow, R. E., & Havrilesky, L. J. (2015). Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention. Gynecol Oncol, 138(3), 694–699. https://doi.org/10.1016/j.ygyno.2015.06.013
Dottino, Joseph A., William A. Cliby, Evan R. Myers, Robert E. Bristow, and Laura J. Havrilesky. “Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention.Gynecol Oncol 138, no. 3 (September 2015): 694–99. https://doi.org/10.1016/j.ygyno.2015.06.013.
Dottino JA, Cliby WA, Myers ER, Bristow RE, Havrilesky LJ. Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention. Gynecol Oncol. 2015 Sep;138(3):694–9.
Dottino, Joseph A., et al. “Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention.Gynecol Oncol, vol. 138, no. 3, Sept. 2015, pp. 694–99. Pubmed, doi:10.1016/j.ygyno.2015.06.013.
Dottino JA, Cliby WA, Myers ER, Bristow RE, Havrilesky LJ. Improving NCCN guideline-adherent care for ovarian cancer: Value of an intervention. Gynecol Oncol. 2015 Sep;138(3):694–699.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

September 2015

Volume

138

Issue

3

Start / End Page

694 / 699

Location

United States

Related Subject Headings

  • United States
  • Practice Guidelines as Topic
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Models, Economic
  • Markov Chains
  • Humans
  • Guideline Adherence
  • Female
  • Cost-Benefit Analysis