Minimally invasive surgery is cost-effective compared with laparotomy for early-stage ovarian cancer, according to a study presented at the virtual 2021 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

“For women with suspicious ovarian cysts of varying risk of malignancy, treatment often involves minimally invasive surgery,” explained Shayan Dioun, MD, Columbia Medical Center, New York, NY, during his presentation.

“While there are a number of benefits to minimally invasive surgery, there is an increased risk of ovarian capsule rupture during the procedure compared to laparotomy. Capsule rupture has the potential to seed the abdominal cavity with the malignant cells,” he continued.

A decision model was developed to compare the risks, benefits, and effectiveness of minimally invasive surgery vs laparotomy in women with ovarian masses. The model allocated patients 1:1 to minimally invasive surgery and open surgery and included a time horizon of 4 years. Perioperative morbidity and mortality were integrated into the model.

The primary outcome measure was incremental cost-effectiveness ratio (ICER) expressed in 2018 US dollars divided by the difference is quality adjusted life years (QALYs).

The study found that minimally invasive surgery was the least costly strategy at $7732 compared with $17,899 for laparotomy.

In a hypothetical cohort, there were 64 cases of ovarian rupture in the minimally invasive surgery group and 53 in the laparotomy group. In addition, there were 26 cancer related deaths in the minimally invasive surgery group in 25 in the laparotomy group.

Minimally invasive surgery was cost-effective with a cost saving ICER of $109,237 per QALYs compared to laparotomy. In one way sensitivity analyses the probability of cancer and risk of rupture did not substantially impact the cost-effectiveness. In Monte Carlo simulation, minimally invasive surgery remained cost-effective in 100% of the cases.

“In conclusion minimally invasive surgery constitutes a cost-effective management strategy for women with suspicious ovarian masses even though it is associated with both an increased risk of capsule rupture and death from ovarian cancer,” Dr Dioun concluded.—Janelle Bradley

Dioun S, Chen L, Gockley A, et al. Cost-effectiveness of minimally invasive surgery for women with ovarian masses. Presented at: the virtual 2021 SGO Annual Meeting on Women’s Cancer; March 19-25, 2021.