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J Thorac Cardiovasc Surg 2004;127:1366-1372
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: A combined analysis from the University of Texas M. D. Anderson and Memorial Sloan-Kettering Cancer Centers

^a Dalhousie University, Halifax, Nova Scotia, Canada
^b The University of Texas M. D. Anderson Cancer Center, Houston, Tex,USA
^c Memorial Sloan-Kettering Cancer Center, New York, NY, USA,
^d The University of Singapore, Singapore, Singapore

Received for publication September 23, 2003; revisions received November 13, 2003; revisions received November 20, 2003; accepted for publication November 20, 2003.

^* Address for reprints: Geoffrey A. Porter, MD, Department of Surgery, 7-007 QEII Health Sciences Center, Dalhousie University, 1278 Tower Rd, Halifax, Nova Scotia, Canada B3H 2Y9
Geoff.Porter{at}dal.ca

BACKGROUND: We sought to determine the cost-effectiveness of different treatment strategies for patients with pulmonary metastases from soft tissue sarcoma.

METHODS: We constructed a decision tree to model the outcomes of 4 treatment strategies for patients with pulmonary metastases from soft tissue sarcoma: pulmonary resection, systemic chemotherapy, pulmonary resection and systemic chemotherapy, and no treatment. Data from 1124 patients with pulmonary metastases from soft tissue sarcoma were used to estimate disease-specific survival for pulmonary resection and no treatment. Outcomes of systemic chemotherapy and pulmonary resection and of systemic chemotherapy were estimated by assuming a 12-month improvement in disease-specific survival with chemotherapy; this was done on the basis of the widely held but unproven assumption that chemotherapy provides a survival benefit in patients with metastatic soft tissue sarcoma. Direct costs were examined for a series of patients who underwent protocol-based pulmonary resection or doxorubicin/ifosfamide-based chemotherapy.

RESULTS: The mean cost of pulmonary resection was $20,339 per patient; the mean cost of 6 cycles of chemotherapy was $99,033. Compared with no treatment and assuming a 12-month survival advantage with chemotherapy, the incremental cost-effectiveness ratio was $14,357 per life-year gained for pulmonary resection, $104,210 per life-year gained for systemic chemotherapy, and $51,159 per life-year gained for pulmonary resection and systemic chemotherapy. Compared with pulmonary resection, the incremental cost-effectiveness ratio of pulmonary resection and systemic chemotherapy was $108,036 per life-year gained. Sensitivity analyses showed that certain patient and tumor features, as well as the assumed benefit of chemotherapy, affected cost-effectiveness.

CONCLUSIONS: For patients with pulmonary metastases from soft tissue sarcoma who were surgical candidates, pulmonary resection was the most cost-effective treatment strategy evaluated. Even with favorable assumptions regarding its clinical benefit, systemic chemotherapy alone, compared with no treatment, was not a cost-effective treatment strategy for these patients.

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