Elise Wilson

Cost-Effectiveness of Combined Minimally Invasive Hysterectomy and Bariatric Surgery in Women With Morbid Obesity and Endometrial Hyperplasia or Early-Stage Endometrial Cancer

We studied the cost-effectiveness of simultaneous bariatric surgery and minimally invasive hysterectomy (MIH) (combined surgery) in comparison to MIH alone in endometrial cancer (EC) survivors with obesity-related disease (ORD). Cost-effectiveness analysis. Hypothetical cohort of women aged 50 to 69 with obesity (BMI ≥ 30 kg/m Combined surgery vs MIH alone. We constructed a decision-analytic model with lifetime horizon to compare life expectancy and lifetime healthcare costs between patients with combined surgery and those with MIH alone. Utility weights, a measure of health states that affect quality of life, from published studies were used to calculate quality-adjusted life years (QALYs). Lifetime healthcare costs associated with ORD and costs for MIH and surgical complications were obtained from published studies. Costs for combined surgery were obtained from a single institution. All costs were evaluated from the healthcare sector perspective and presented in US dollars at the 2022 price level. Future costs and QALYs were discounted to present values using an annual rate of 3%. For the 50 to 59 age group, QALYs for combined surgery were 14.8 compared with 11.0 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $186 124 compared with $335 995 for MIH alone. For the 60 to 69 age group, QALYs for combined surgery were 12.0 compared with 7.9 for MIH alone. The lifetime healthcare cost for patients with combined surgery was $155 451 compared with $273 403 for MIH alone. Combined surgery yielded higher QALYs and lower costs than MIH alone. For women with endometrial intraepithelial neoplasia or early-stage EC with obesity and ORD, combined surgery may represent a cost-saving and QALYs-improving option for treatment. However, barriers to this approach may be insurmountable.

Challenges in implementation of molecular classification in early stage endometrial cancer—An NRG Oncology cooperative group mixed‐methods study

AbstractBackgroundProfessional guidelines recommend molecular profiling for mismatch repair (MMR), p53, and polymerase epsilon (POLE) status in endometrial cancer (EC). However, adoption in the United States has not been documented, and barriers to the implementation of testing have not been described.MethodsIn this mixed‐methods study, implementation science frameworks were used to develop a quantitative survey. Gynecologic oncologists, medical oncologists, radiation oncologists, and pathologists affiliated with NRG Oncology programs were contacted through snowball sampling and were surveyed during 2022–2023. A subset of respondents was interviewed. Statistical and thematic analyses were performed.ResultsAt least 403 NRG Oncology‐affiliated providers were contacted for the survey, and 107 (26.6%) responded. Greater than 90% of respondents perceived POLE, MMR, and p53 status as important for clinical care. MMR and p53 tests were perceived as easy to obtain, but only 24.2% of respondents reported that POLE testing was moderately or very easy to obtain. Respondents from academic sites reported better access to molecular classification and perceived greater importance of molecular classification compared with respondents from community sites. In thematic analysis of 13 qualitative interviews, cost concerns were reported as large barriers to testing. Interviewees reported a desire for prospective data to guide treatment selection based on classification results.ConclusionsAlthough integrating molecular classification into standard pathologic reporting is recommended, and clinicians perceive molecular profiling in early stage EC as important, survey respondents noted significant implementation barriers. Implementation challenges that differ between community oncology and academic practice settings were identified. Strategies to improve equitable access to molecular classification of early stage EC are needed.