Cost-effectiveness of perioperative thromboprophylaxis in women undergoing laparoscopic surgery for a gynecologic malignancy

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Abstracts / Gynecologic Oncology 141 (2016) 2–208

economic strategy to prevent VTE. Therefore, it should be considered in women undergoing laparoscopic surgery for gynecologic malignancies. doi:10.1016/j.ygyno.2016.04.306

275 – Poster Evaluating racial molecular complexity in gynecologic cancers J.M. Scalicia, J.G. Rossb, L. Madeira da Silvaa, W. Nicolsona, M.D. Harmona, S. Boudreaua, B. Wangc, M.A. Finana, R.P. Rocconia. aMitchell Cancer Institute, University of South Alabama, Mobile, AL, USA, bThe University of Chicago Medicine, Chicago, IL, USA, cUniversity of South Alabama, Mobile, AL, USA

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Objectives: Understanding the molecular pathways that drive gynecologic cancer cells is common. However, using this knowledge for targeting actionable mutations incorporates molecular and population sciences. We aim to evaluate the complexity that race could play in this role. Methods: Pretreatment tumor samples from surgery or image-guided core biopsies were obtained and sent to a third party commercial molecular profiling company. A total of 148 biomarkers were tested using various methods of immunohistochemistry, chromogenic or fluorescent in situ hybridization, reverse transcriptase–polymerase chain reaction, Illumina microarray, or next generation sequencing. “Positive” results demonstrate mutations, overexpression, or positivity of methods used for actionable biomarkers. Patients were grouped by self-designated race and molecular profiling results were compared using appropriate statistics with odds ratio (95% CI) to determine correlation to race. Results: Molecular profiling was performed on 175 patients from 2012 to 2015. Racial breakdown was as follows: 141 (79%) patients were white and 34 (24%) were black. The majority of samples were ovarian cancer (n = 127, 71%) and advanced stage III/IV disease (n = 139, 78%). A total of 1,979 positive results were found in the entire cohort, with 1,497 in whites and 436 in black patients. Compared with white patients, blacks demonstrated increased number of positive results per patient (10.6 vs12.8, P = .04). Biomarkers that demonstrated positive results in frequencies greater than a third of the patients were higher in black patients (12 biomarkers, 8.2%) compared with whites (7 biomarkers, 4.7%) (P = .03). Odds ratios for biomarkers more commonly found in black patients were significant for HSP90AA1 (OR 0.067, 95% CI 0.007–0.54, P = .028), IGFBP (OR 4 0, 95% CI 0–0.49, P = .04), PD-1 (OR 0.218, 95% CI 0.05–0.93, P = .04), and PD-L1 (OR 0.12, 95% CI 0.03–0.5, P = .005). Conclusions: Molecular profiling demonstrated that black patients had higher levels of complexity with greater number of positive results per patient and more biomarkers with high-frequency positive results. These data demonstrate the need for further molecular and population studies to tease out the effects of race and ethnicity on the malignant properties of gynecologic cancer cells.

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274 – Poster Cost-effectiveness of perioperative thromboprophylaxis in women undergoing laparoscopic surgery for a gynecologic malignancy D.R. Roque, W.Z. Wysham, P.A. Gehrig, S.B. Wheeler, K.H. Kim. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

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Objectives: To evaluate the costs associated with perioperative thromboprophylaxis with sequential compression devices (SCD) alone or in combination with single-dose low-molecular-weight heparin (LMWH) versus no prophylaxis in women undergoing laparoscopic surgery for a gynecologic malignancy. Methods: A decision-tree model was constructed to evaluate the cost of perioperative prophylaxis with SCD +/- LMWH versus no prophylaxis in women undergoing laparoscopic surgery for a gynecologic malignancy. Transition probabilities were estimated from the current published peer-reviewed literature. Quality adjusted–life years (QALY), number of venous thromboembolic events (VTE) averted, number of pulmonary embolisms (PE) averted, and costs were modeled over a horizon of 12 months. Assuming a US public payer perspective, incremental cost-effectiveness ratios (ICER) were evaluated as the incremental cost per QALY gained as well as the incremental cost per VTE and PE averted per life-year. To evaluate the robustness of our results, we performed a probabilistic sensitivity analyses. Results: The ICER associated with SCD alone compared with no prophylaxis were $84,550 per QALY gained, $2,827 per VTE averted, and $19,553 per PE averted. Meanwhile, combination therapy (SCD + LMWH) cost $1,134,579 less than no prophylaxis and resulted in 7 additional QALY, as well as 100 VTE averted and 14 less PE. Varying transition probabilities, costs, and utilities across the expected distribution of each parameter resulted in 56% and 53% of ICER estimates for SCD alone and SCD + LMWH, respectively, falling below the commonly accepted willingness to pay (WTP) threshold of $50,000/QALY gained. Compared with no prophylaxis, SCD and SCD + LMWH were associated with cost savings and higher number of VTEs averted in 26% and 55% of ICER estimates, respectively. Furthermore, SCD and SCD + LMWH were also associated with cost savings and higher number of PE averted in 26% and 57% of ICER estimates, respectively. Conclusions: Combination perioperative prophylaxis with SCD + LMWH is associated with cost savings and appears to be the most dominant

doi:10.1016/j.ygyno.2016.04.307

276 – Poster Development and validation of chemoradio-prediction model using reverse-phase protein arrays in locally advanced cervical cancer C.H. Choia, J.Y. Chungb, E.J. Heoa, E.S. Paika, H.J. Choia, M.K. Kimc, Y.Y. Leea, T.J. Kimd, J.W. Leed, B.G. Kimd, D.S. Baed, S.M. Hewittb. aSamsung Medical Center, Seoul, South Korea, bNational Cancer Institute, Bethesda, MD, USA, cSungkyunkwan University School of Medicine, Changwon-Si, South Korea, dSamsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea