Clinical outcomes and cost-effectiveness of primary treatment of ovarian cancer in North-Western Romania.

Ovarian cancer has the poorest survival rate among gynaecological malignancies. Besides the comparison of different therapeutic strategies aimed to improve outcomes, studies have also begun to focus on aspects of cost-effectiveness of these strategies. In this context, we proposed to evaluate the survival impact, costs and cost-effectiveness of two primary treatment options, primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT), in patients with advanced ovarian cancer treated in a tertiary cancer center of the North-Western Romania.The study included patients with stages IIIC and IV ovarian cancer treated at the "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, between 2008-2011, by either PDS or NACT. Survival was the measure of the effectiveness of the two treatments. A cost-effectiveness analysis was carried out by estimating the incremental cost-effectiveness ratio (ICER) and the average cost-effectiveness ratio (ACER).There was no significant difference in overall survival between the two treatment groups. The median costs for the NACT subgroup were 3580.41 € compared to 2990.19 € for the PDS subgroup, with an incremental cost of 590.22 €. The effectiveness measured in years of survival was 3.34 years for NACT and 3.57 years for PDS. The corresponding median ICER was -2566.17 €/year of survival. ACER was higher for NACT compared to PDS (1071.98 vs. 837.59 €/year of survival).Despite the higher costs, NACT did not prove to be a more effective therapeutic strategy in terms of survival of patients with stage IIIC/IV ovarian cancer. Altogether, our results state that NACT might be less cost-effective than PDS.