Costs of treatment for elderly women with advanced ovarian cancer in a Medicare population

• NACT and PDS are comparable in cost for women with stage IIIC EOC.
• PDS is 12% more expensive for women with stage IV EOC.
• Increasing Charlson score was associated with an increase in 7-month cost of care in both stages.

ObjectiveTo analyze the cost of treating women with advanced stage epithelial ovarian cancer (EOC) undergoing primary debulking surgery (PDS) or neo-adjuvant chemotherapy (NACT).MethodsThe Surveillance, Epidemiology, and End Results (SEER) — Medicare database (1992 to 2009) was used to evaluate the 7-month cost of care following PDS and NACT for advanced EOC. Multivariate analyses were used to evaluate differences between women treated by PDS and NACT on cost and survival.ResultsOf the 4506 women eligible for analysis, 82.4% underwent PDS and 17.6% received NACT. Eighty-five percent with stage IIIC and 78.5% with stage IV EOC underwent PDS (p < 0.0001). No significant difference in the median cost of care between PDS and NACT existed in women with stage IIIC EOC ($59,801 vs. $59,905). There was a 12% increase in adjusted cost of care for stage IV patients ($63,131 vs. $55,302) who received PDS (p < 0.0001). Increasing Charlson score was associated with an increase in 7-month cost of care in both stages. NACT was associated with a decreased 5-year overall survival in women with stage IIIC EOC (HR = 1.27, 95% CI: 1.10–1.47) and stage IV EOC (HR = 1.19, 95% CI: 1.03–1.37) compared to PDS.ConclusionNACT and PDS are comparable in cost for women with stage IIIC EOC, and PDS is minimally more expensive for women with stage IV EOC. PDS was associated with an increase 5-year overall survival. Future investigations should include cost-effectiveness analyses where additional measures such as quality adjusted life years and propensity scored survival are included.