COST-EFFECTIVENESS ANALYSIS OF COMPLIANCE WITH CLINICAL PRACTICE GUIDELINES IN SARCOMA TREATMENT: AN ECONOMIC EVALUATION IN TWO EUROPEAN REGIONS

OBJECTIVES: Sarcomas are rare tumours (1-2% of all cancers) with high discordance in diagnosis and low compliance with clinical practice guidelines (CPG). The objective was then to perform a cost-effectiveness analysis (CEA) of compliance with CPG compared to non compliance in the treatment of sarcoma. METHODS: The study included patients aged 15 years with histological diagnosis of sarcoma treated at the University hospital of Lyon and/or Léon Bérard Cancer centre (Rhône- Alpes region, France) in 2005/2006 or in public hospitals of Veneto (Italy) in 2007. The time horizon was three years post diagnosis. The hospital’s perspective was adopted, based on amicrocosting approach. All costs were expressed in euros 2009. A 4% annual discount rate was applied to both costs and effects. Incremental Cost Effectiveness Ratios (ICER) were expressed as costs per life year gained, per diseasefree year gained, and per relapse-free year gained when treatments were compliant with CPG compared to not compliant. Probabilistic sensitivity analyses were performed based on 10000 bootstrap replications both with and without adjusting data to grade. RESULTS: A total of 219 patients were included in the study. Compliance with CPG was observed for 118 patients (54%). Average total costs reached €23,571 when treatment was in accordance with CPG and €27,313 otherwise. Compliance with CPG strictly dominates for disease-free and relapse-free survivals. When handling uncertainty, probabilities that compliance with CPG still strictly dominates were 33%, 63% and 88% for overall, disease-free, and relapse-free survivals, respectively. When costs and effects were adjusted to grade, probabilities reached 17%, 48% and 75%, respectively. CONCLUSIONS: Given that few cost-effectiveness analyses have examined compliance with CPG in rare tumours, these results are promising and should encourage physicians’ efforts to increase their compliance to CPG.