Cost analysis of adjuvant management strategies in early stage (stage I) testicular seminoma

Figures & data

Table 1 National Comprehensive Cancer Network follow-up guidelines by modality

Description	Quantity	Quantity
	2011	2012
Surveillance
E&M expanded/low MDM PF	20	14
CT abdomen and pelvis with contrast	20	7
Alpha-fetoprotein	20	14
Lactate dehydrogenase	20	14
Human chorionic gonadotropin	20	14
Single-agent carboplatin
E&M expanded/low MDM PF	20	16
CT abdomen and pelvis with contrast	20	3
Alpha-fetoprotein	20	16
Lactate dehydrogenase	20	16
Human chorionic gonadotropin	20	16
RT (PA nodes only)
E&M expanded/low MDM PF	13	14
CT abdomen and pelvis with contrast	3	3
Alpha-fetoprotein	14	14
Lactate dehydrogenase	14	14
Human chorionic gonadotropin	14	14
RT (dog-leg)
E&M expanded/low MDM PF	13	14
CT abdomen and pelvis with contrast	0	0
Alpha-fetoprotein	13	14
Lactate dehydrogenase	13	14
Human chorionic gonadotropin	13	14

Abbreviations: CT, computed tomography; E&M, evaluation and management; MDM, medical decision making; PA, para-aortic; PF, patient follow-up; RT, radiotherapy.

Table 2 Treatment and follow-up reimbursement comparison between 2011 and 2012

Adjuvant strategy	2011 Medicare combined charges	2012 Medicare combined charges
Surveillance	$18,801	$8,458
Carboplatin	$19,758	$7,263
PA-RT	$11,031	$11,192
DL-RT	$8,908	$9,176

Abbreviations: DL, dog-leg; PA, para-aortic; RT, radiation therapy.

Table 3 Weighted reimbursement model (2011) for each modality factoring in salvage BEP

2011 Reimbursement	Total before factoring salvage including FU	Relapse %	BEP costs	Total with salvage
Observation	$18,801	0.18	$12,139.00	$20,986.02
Adjuvant RT
PA RT	$11,031.00	0.04	$12,139.00	$11,516.56
Dog-leg RT	$8,908.00	0.04	$12,139.00	$9,393.56
Single-cycle carboplatin	$19,758.00	0.05	$12,139.00	$20,364.95

Abbreviations: FU, follow-up; BEP, bleomycin, etoposide, cisplatin; PA, para-aortic; RT, radiation therapy.

Table 4 Weighted reimbursement model (2012) for each modality factoring in salvage BEP

2012 Reimbursement	Total before factoring salvage including FU	Relapse %	BEP costs	Total with salvage
Observation	$8,458.00	0.18	$12,139.00	$10,643.02
Adjuvant RT
PA RT	$11,192.00	0.04	$12,139.00	$11,677.56
Dog-leg RT	$9,176.00	0.04	$12,139.00	$9,661.56
Single-cycle carboplatin	$7,263	0.05	$12,139.00	$7,869.95

Abbreviations: FU, follow-up; BEP, bleomycin, etoposide, cisplatin; PA, para-aortic; RT, radiation therapy.

Table 5 ICER analysis comparing surveillance (with or without factoring in reimbursement for BEP salvage) with alternative adjuvant management strategies

	ICER analysis not factoring BEP salvage therapy	ICER analysis factoring BEP salvage therapy
Surveillance versus carboplatin	$10,307.69	$–1,831.00
Surveillance versus PA-RT	$19,528.57	$–7,318.00
Surveillance versus DL-RT	$5,128.57	$–7,010.00

Abbreviations: ICER, incremental cost-effectiveness ratio; BEP, bleomycin, etoposide, cisplatin; $–, no incremental benefit for surveillance when compared with alternative management strategy; PA, para-aortic; DL, dog-leg; RT, radiation therapy.