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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

BMC Health Services Research > Ausgabe 1/2012
Lionel Perrier, Alessandra Buja, Giuseppe Mastrangelo, Antonella Vecchiato, Paolo Sandonà, Françoise Ducimetière, Jean-Yves Blay, François Noël Gilly, Carole Siani, Pierre Biron, Dominique Ranchère-Vince, Anne-Valérie Decouvelaere, Philippe Thiesse, Christophe Bergeron, Angelo Paolo Dei Tos, Jean-Michel Coindre, Carlo Riccardo Rossi, Isabelle Ray-Coquard
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-82) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

LP, AB, GM designed the study, acquired and interpreted the clinical and cost data, undertook the statistical analysis, and prepared the manuscript. AV, PS, FD participated in clinical data acquisition and analysis. FNG carried out surgical data acquisition and analysis, PB chemotherapy data acquisition and analysis, DRV, AVD, APDT, JMC, and PT diagnosis data acquisition and analysis, and CB the analysis of data from young patients. CS participated in the statistical analysis. JYB, CRR and IRC participated in general CONTICANET coordination as well as study design and compliance supervision. All authors read and approved the final manuscript.



Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs) remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET) comparing costs and outcomes when clinicians adhered to CPGs and when they did not.


Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006) or in the Veneto region of Italy (in 2007). Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach). All costs were expressed in euros (€) at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER) was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method.


A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%). Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%.


Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of sarcoma.
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