MP11-20 COST-EFFECTIVENESS ANALYSIS OF NON-RISK-ADAPTED ACTIVE SURVEILLANCE FOR POST-ORCHIECTOMY MANAGEMENT OF CLINICAL STAGE I SEMINOMAS

Abstract

INTRODUCTION AND OBJECTIVE: The cancer-specific survival for men with Clinical Stage I (CSI) seminoma approaches 100% regardless of management approach after orchiectomy. Given the young age and high survival rate of these patients, there has been a shift towards minimizing treatment-related morbidity and cost. In this context, non-risk-adapted active surveillance (NRAS) has emerged as a desirable management strategy. We aimed to evaluate the clinical and economic value of a NRAS-for-all approach to CSI seminoma patients. METHODS: We developed a decision analytic Markov model to estimate the costs and health outcomes of competing post-orchiectomy management strategies for otherwise-healthy 30-year-old men with CSI seminoma. We compared NRAS for all patients to three strategies: adjuvant para-aortic radiotherapy (RT) (reference 1), adjuvant chemotherapy with 1 cycle of carboplatin (reference 2), and a mix of active surveillance (39%), adjuvant chemotherapy (46%), and adjuvant radiotherapy (15%) based on current real-world practice patterns (reference 3). Active surveillance was performed following the National Comprehensive Cancer Network guidelines. Patients who developed recurrent disease received salvage chemotherapy with 3 cycles of bleomycin, etoposide, and cisplatin regardless of initial strategy. We assessed health utilities, measured in quality adjusted life-years (QALYs), and direct medical costs over 10 years from the perspective of health care payers in the United States. Costs and utilities were discounted 3% per year. We calculated the incremental cost-effectiveness ratio (ICER) for NRAS versus each reference arm, with a willingness to pay threshold of $50,000/QALY. Univariate and multivariate sensitivity analyses were performed to assess the robustness of model findings. RESULTS: The 10-year all-cause mortality rate was 2.4%, 1.9%, 2.2%, and 2.5%, respectively, for references 1-3 and NRAS. NRAS dominated all reference arms, offering the lowest costs ($6,790 for NRAS vs. $13,406, $9,367, $8,941 for references 1-3) and the highest QALYs gained (7.75 for NRAS vs. 7.53, 7.54, 7.62 for references 1-3) per patient over the 10-year period. Similar findings were observed across a wide range of values tested for model input parameters. CONCLUSIONS: NRAS spares patients from treatment-related morbidity and is cost-effective compared to other existing management strategies. Increased utilization of NRAS for CSI seminoma can maintain a comparable survival rate while lowering treatment-related financial and health burdens.