Cost-utility-analysis of molecular-integrated-profile for women with (high)intermediate risk endometrial cancer - PORTEC-4a an international, randomised, phase 3 trial

Author(s):
Heerik, A.S.V.M. van den; Horeweg, N. (0000-0002-8581-4753); Haverkort, M.A.D.; Kuijsters, N.; Kommoss, S.; Koppe, F.L.A.; Nowee, M.E.; Westerveld, H.; Jong, M.A.A. de; Frühauf, F.; Cnossen, J.S.; Mens, J.W.M.; Beukema, J.C.; Chargari, C.; Gillham, C.; Tseng, D.S.J.; Vandecasteele, K.; Hamann, M.; Kiderlen, M.; Polterauer, S.; Staebler, A.; Nijman, H.W.; Wortman, B.G.; Boer, S.M. de (0000-0002-8454-1597); Verhoeven-Adema, K.W.; Nout, R.A.; Putter, H.; Smit, V.T.H.B.M.; Creutzberg, C.L. (0000-0002-7008-4321); Hout, W.B. van den
Published
2026
Publication type
Article / Letter to editor

Abstract

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 (& euro;11,898 vs & euro;13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (& euro;9,995 vs & euro;11,926, p < 0.01), while there was no significant difference in treatment for recurrence (& euro;1,903 vs & euro;1,121, p = 0.17). At a willingness-to-pay threshold of & euro;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.

Endometrial cancerMolecular profileMolecular-guided adjuvant treatmentIndividualised treatmentOmission of treatmentQALYsCost-effectiveness
Date issued
2026-02-11
Language
English
Publisher
ELSEVIER IRELAND LTD
Is part of
Radiotherapy & Oncology
hdl
1887/4310392
doi
10.1016/j.radonc.2026.111406