Abstract
METHODS
The expenditure of the Dutch health care system between 2017 and 2025 associated with the introduction of HIPEC for patients with stage III ovarian cancer eligible for interval CRS (target population) was assessed during their entire treatment course (surgical and subsequent treatment). Cost estimates are based on national registry data, national benchmark costs for hospital-related activities, list prices for drugs, therapeutic guidelines, and expert opinion. Sensitivity and scenario analyses were performed to test robustness of the analysis.
CONCLUSION
Within the Dutch health care system, the surgical budget impact of HIPEC is acceptable and falls within the boundaries for reimbursement of the responsible decision-making bodies. The total budget impact is mostly affected by the high costs of systemic treatment after prolonged recurrence-free survival due to HIPEC.
RESULTS
The Dutch target population is expected to increase from 200 patients in 2017 to 233 patients in 2025, with 80% receiving HIPEC in 2025. Between 2017 and 2025, the impact on the annual surgical budget is €3.5 million, of which €1.8 million is directly attributable to HIPEC and its associated costs. When considering the cost of all ovarian cancer-related treatments, an additional €30,898 per HIPEC patient is spent in 2025, mainly driven by prolonged recurrence-free survival resulting in extended maintenance therapy and treatment for more platinum-sensitive recurrences. This leads to an annual total treatment budget impact of €26 million in 8 years, with €5.7 million directly associated with HIPEC use.
PURPOSE
The OVHIPEC-1 trial demonstrated that adding hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) for patients with stage III epithelial ovarian cancer results in a significant increase in recurrence-free survival and overall survival. To inform policymakers about the macroeconomic budget, we conducted a budget impact analysis.