Cost and risk benefit in the management of clinical stage II nonseminomatous testicular tumors.
Two similarly effective treatment options exist for managing clinical low volume Stage II non-seminomatous germ cell testis tumors (NSGCT).
Primary retroperitoneal lymph node dissection (RPLND) (with immediate adjuvant chemotherapy or chemotherapy at relapse) and primary chemotherapy have resulted in similar survival rates in large series.
Because the chance for cure is similar with either approach, the cost and morbidity of therapy should be considered important discriminating factors in deciding which option to pursue for an individual patient.
The purpose of this study was to undertake a cost/benefit and risk/benefit analysis of these two options using data and costs from the Indiana University experience.
The overall direct costs for 100 patients undergoing primary RPLND were compared with the total direct costs of 100 patients receiving primary chemotherapy for low volume Stage II disease, including the costs of adjuvant chemotherapy, salvage chemotherapy in relapsing patients, and routine follow-up for a 5-year period.
Treatment decisions for patients with clinical low volume Stage II NSGCT may be based on cost/benefit and risk/benefit considerations, including relative toxicity, long term cure rate, and individual patient preference.
Patient compliance with follow-up, the specific expertise of the physicians, and the availability of specialized therapeutic care ultimately may influence such decisions.
Mots-clés Pascal : Tumeur non séminomateuse, Testicule, Homme, Lymphadénectomie, Rétropéritonéal, Chimiothérapie, Anticancéreux, Traitement, Résultat, Complication, Analyse avantage coût, Etude comparative, Stade précoce, Economie santé, Appareil génital mâle pathologie, Testicule pathologie, Tumeur maligne, Chirurgie
Mots-clés Pascal anglais : Non seminomatous tumor, Testicle, Human, Lymphadenectomy, Retroperitoneal, Chemotherapy, Antineoplastic agent, Treatment, Result, Complication, Cost benefit analysis, Comparative study, Early stage, Health economy, Male genital diseases, Testicular diseases, Malignant tumor, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0555841
Code Inist : 002B20B02. Création : 01/03/1996.