TY - JOUR
T1 - Cost-utility-analysis of molecular-integrated-profile for women with (high)intermediate risk endometrial cancer - PORTEC-4a an international, randomised, phase 3 trial
AU - van den Heerik, Anne Sophie V M
AU - Horeweg, Nanda
AU - Haverkort, Marie A D
AU - Kuijsters, Nienke
AU - Kommoss, Stefan
AU - Koppe, Friederike L A
AU - Nowee, Marlies E
AU - Westerveld, Henrike
AU - de Jong, Maria A A
AU - Frühauf, Filip
AU - Cnossen, Jeltsje S
AU - Mens, Jan Willem M
AU - Beukema, Jannet C
AU - Chargari, Cyrus
AU - Gillham, Charles
AU - Tseng, Dorine S J
AU - Vandecasteele, Katrien
AU - Hamann, Moritz
AU - Kiderlen, Mandy
AU - Polterauer, Stephan
AU - Staebler, Annette
AU - Nijman, Hans W
AU - Wortman, Bastiaan G
AU - De Boer, Stephanie M
AU - Verhoeven-Adema, Karen W
AU - Nout, Remi A
AU - Putter, Hein
AU - Smit, Vincent T H B M
AU - Creutzberg, Carien L
AU - van den Hout, Wilbert B
N1 - Publisher Copyright:
© 2026 The Authors
PY - 2026/1/30
Y1 - 2026/1/30
N2 - Purpose: The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes. Patients and methods: Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data. Results: All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (p = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, p < 0.01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, p = 0.17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective. Conclusion: Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.
AB - Purpose: The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes. Patients and methods: Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data. Results: All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (p = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, p < 0.01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, p = 0.17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective. Conclusion: Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.
U2 - 10.1016/j.radonc.2026.111406
DO - 10.1016/j.radonc.2026.111406
M3 - Article
C2 - 41621679
SN - 0167-8140
VL - 217
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
M1 - 111406
ER -