Economic evaluations and health economic models of soft tissue sarcomas: Systematic literature review from a European and North American perspective.

Background: Soft tissue sarcomas (STS) are a group of solid tumors with over 50 histologic types. They account for < 1 % of new malignancies in adults and ∼2 % of cancer-related mortality. Surgery with or without radiation therapy is applied in localized STS, however, most patients develop local recurrence or metastases after surgery. This study aimed to review the literature on economic evaluations and health economic models in STS.

Methods: Systematic literature search was performed covering Medline, Embase, Scopus, Cochrane Library and PROSPERO. Searches in grey literature and snowball searches were applied. Studies were eligible if they included patients with STS, contained data on health economic evaluations, had a geographical focus on Europe or North America and were written in English. The protocol was registered in PROSPERO (ID: CRD42023483406).

Results: The review of 1638 records resulted in 22 peer-reviewed articles, 5 HTA agency documents and 2 conference posters. Among these, 19 compared pharmaceutical therapies and the remaining studies focused on diagnostics or surgery related interventions. All studies on pharmaceuticals investigated advanced STS, where patients have metastatic or locally advanced irresectable disease. Economic modelling was used in 25 studies; majority of them used the "traditional" 3-state Markov cohort or partitioned-survival modelling approach (health states: progression-free; progressed; dead).

Conclusions: Although a fairly large number of publications are available on the economic evaluation of STS, these mostly focus on a narrow patient sub-group, not eligible for surgery. The applied methodology of modelling, especially for pharmaceuticals, is mostly simplified and universally used across different jurisdictions.