OBJECTIVES: To examine the empirical and methodological cost-effectiveness evidence of surgical interventions for breast, colorectal, and prostate cancer.
METHODS: Systematic searches of seven databases including MEDLINE, EMBASE, CDSR,HTA, DARE, EconLit and NHSEED, research registers, the National Institute of Health and Care Excellence (NICE) website and conference proceedings was conducted in April 2012. Studies were included if they evaluated the cost-effectiveness of a surgical procedure in either breast, colorectal or prostate cancer and reported cost per quality adjusted life-year or cost per life-year results. The quality of the studies included was assessed in terms of meeting essential, preferred, and UK specific requirements for economic evaluations.
RESULTS: The 17 (breast=3,colorectal=7,prostate=7) studies which satisfied the inclusion criteria covered a broad range of settings with 9 set in European and 8 in non-European locations. Just a third (11/17) was published within the last 10 years. In terms of the essential quality criteria; the populations, interventions and comparators were generally well defined. However, very few studies were informed by the results of literature reviews or synthesised clinical evidence. Although the interventions had potential differential effects on recurrence and mortality rates, some studies used relatively short time horizons. Although univariate sensitivity analyses were reported in all studies, less than a third characterised all uncertainty with a probabilistic sensitivity analysis. While a third of studies incorporated patients’ health-related quality of life data, only 4 of the 17 studies used social tariff values.
CONCLUSIONS: There is very little recent robust evidence describing the cost-effectiveness of surgical interventions in these indications. Many of the more recent publications did not satisfy the essential methods requirements, such as using synthesising clinical evidence informed by a systematic literature review. Given the ratio of potential benefit and harm associated with surgery in cancer, there is an urgent need to conduct additional robust economic evaluations in this area.
