OBJECTIVES: Soft tissue sarcomas (STS) are a group of solid tumors with over 50 histologic subtypes. They account for <1% of all 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 related to STS.

METHODS: The systematic literature search was performed on 22nd of August 2023, covering Medline, Embase, Scopus, Cochrane Library and PROSPERO. We also searched in grey literature sources and applied snowball searches. 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 ISPOR posters. We further investigated 25 studies that applied a health economic model, as 4 used a simple calculation of costs and benefits. Cost-utility analysis was performed in 22 studies. 19 compared pharmaceutical therapies, the majority (n=18) investigated trabectedin, pazopanib or olaratumab. 6 studies focused on diagnostics or surgery related interventions. All studies on pharmaceuticals investigated advanced STS, where patients have metastatic or locally advanced irresectable disease. The simulation of these patients was highly simplified; the “traditional” 3-state Markov cohort or partitioned-survival modelling approach (health states: progression-free; progressed; dead) was used in 18 cases, while the remaining study applied a decision tree.

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.