ABSTRACT
PURPOSE: This study compares the payors' cost of treatment for surgical Stage I endometrial carcinoma with results of published clinical studies to determine which treatment most efficiently uses available resources. METHODS AND MATERIALS: Six options for treatment of surgical Stage I endometrial carcinoma were selected for comparison. The treatment options were observation only, low-dose-rate brachytherapy (LDRB) (nonremote afterloading), LDRB and external beam radiation (EBRT), EBRT only, high-dose-rate brachytherapy (HDRB) only (three applications), and EBRT and HDRB (three applications). The literature was reviewed to obtain disease-free survival (DFS) rates corresponding to the treatment options chosen in surgical Stages IA, IB, and IC. Metaanalysis and sensitivity testing were performed on the collected clinical data. A typical midsized city in Medicare region IV was used as our representative payor cost basis. RESULTS: Thirteen retrospective articles contained sufficient clinical information for analysis. Comparison of DFS between the observation, LDRB, and EBRT treatment groups was made for Stage IA; LDRB and EBRT for Stage IB; and LDRB, EBRT, LDRB +/- EBRT, LDRB + EBRT, and HDRB + EBRT for Stage IC. Meta-analysis failed to reveal statistically significant DFS between the respective treatment options within Stages IA, IB, or IC. The RVUs for each treatment option were LDRB, 21.7; EBRT, 117.1; EBRT + LDRB, 130.7; HDRB, 155.5; and EBRT + HDRB, 264.4. The DRG payment for LDRB is $2714.92. The calculated payor's cost for each treatment option was: LDRB, $3466.62; EBRT, $4053.03; EBRT + LDRB, $7238.55; HDRB, $5381.19; and EBRT + HDRB, $9153.14. CONCLUSION: Our analysis reveals no statistically significant differences in DFS among the treatment options considered within each surgical stage. Observation appears to result in acceptable DFS with minimal cost in Stage IA. Low-dose-rate brachytherapy was the most cost-effective treatment in Stage IB, with no statistically significant difference in DFS between LDRB and EBRT. Although LDRB had inferior DFS compared to other treatment options in surgical Stage IC, this difference failed to reach statistical significance. Our analysis implies, excluding observation, that LDRB may be a more cost-efficient treatment than the other treatment options considered. Further studies stratifying for surgical stage and grade are needed to determine the optimal cost-effective treatment for this common malignancy.
Subject(s)
Endometrial Neoplasms/economics , Health Care Costs/statistics & numerical data , Insurance, Health, Reimbursement/statistics & numerical data , Aged , Analysis of Variance , Cost Control , Cost-Benefit Analysis , Endometrial Neoplasms/pathology , Endometrial Neoplasms/radiotherapy , Female , Health Services Research/methods , Humans , Medicare Part B , Neoplasm Staging , Radiotherapy/economics , Radiotherapy Dosage , Relative Value Scales , United StatesABSTRACT
PIP: The authors measure the effects of paid maternity leave upon infant mortality, the labor force participation of women during their prime childbearing years, and fertility rates. To reach their conclusions, they constructed a simultaneous-equations model using the individual fixed-effects method and a data set comprising 17 OECD countries and four time periods. The extension of maternal leave programs, measured in terms of duration of paid leave, is shown to reduce infant mortality, to raise rates of labor force participation for women in the prime childbearing ages, and to increase birth rates. The direct plus indirect impacts of extending maternity leave programs, as revealed by the reduced-form parameters of the authors' models, however, produce a different picture. The total impacts upon both infant mortality and female labor force participation conform closely to the structural estimates, but the impact upon birth rates almost disappears. It seems that the indirect effects of the maternal leave variable, via infant mortality and women's labor force participation, offset the directly pronatal influence. From a policy perspective, the benefits of paid maternal leave programs would seem to be unconditionally positive with respect to lowering infant mortality, and also positive with respect to raising female labor force participation. One should not, however, expect higher birth rates from such programs. The findings also suggest that maternal leave programs can facilitate some increases in women's labor force participation without incurring the reductions in fertility which would otherwise be experienced.^ieng
