Modeling Management Strategies for Clinical Stage I Seminoma: Direct and Indirect Costs for the First 5 Years

Area of Science:

• Oncology
• Health Economics
• Clinical Management

Background:

• Clinical stage I seminoma treatment options include surveillance, chemotherapy, and radiotherapy, with similar survival rates but varying costs and side effects.
• A comparative cost analysis model was developed to evaluate these three management strategies over the initial five years of treatment.

Purpose of the Study:

• To estimate and compare the direct and indirect costs associated with surveillance, chemotherapy, and radiotherapy for clinical stage I seminoma over a 5-year period.
• To determine the most cost-effective management strategy for early-stage seminoma.

Main Methods:

• A Markov model was utilized to analyze the costs of the three management strategies, assuming 100% compliance with 2012 NCCN Guidelines.
• Model parameters were derived from the Washington State Comprehensive Hospital Abstract Reporting System (CHARS), published literature, and Medicare reimbursement data.
• A 5% annual health inflation rate was incorporated into the cost estimations.

Main Results:

• Surveillance presented the lowest initial cost ($9,065.31) compared to carboplatin chemotherapy and radiotherapy.
• Radiotherapy (145.8 hours) and surveillance (123.0 hours) required more patient time than carboplatin chemotherapy.
• Considering both direct and indirect costs, surveillance emerged as the least expensive management strategy.

Conclusions:

• Surveillance is the most cost-effective and time-effective management strategy for clinical stage I seminoma within the first five years.
• While not assessed, potential long-term side effects of radiotherapy and chemotherapy warrant consideration.
• Surveillance offers a safe, cost-effective, and time-efficient option for managing stage I seminoma.