The Clinical Humanistic and Economic Burden of the Current Management of Patients With Recurrent Malignant Ascites in the UK and Europe
Author(s)
Rainer Mariano Rothe Munoz, II, MSc1, Emillia Pierson, BSc, MSc1, Jennifer Knight, PhD2, Stephanie L. Swift, BSc, PhD3, Carol Forbes, PhD3, Annie Barnes, PhD2, Allister Upton, BSc4, Brenda Dooley, MSc4, Michael Withe, BSc1.
1Pharmanovia, Basildon, United Kingdom, 2AXIS - The Reimbursement Experts, London, United Kingdom, 3SMT Evidence, Leyburn, United Kingdom, 4AXIS - The Reimbursement Experts, Dublin, Ireland.
1Pharmanovia, Basildon, United Kingdom, 2AXIS - The Reimbursement Experts, London, United Kingdom, 3SMT Evidence, Leyburn, United Kingdom, 4AXIS - The Reimbursement Experts, Dublin, Ireland.
OBJECTIVES: Recurrent malignant ascites (rMA) is characterised by the persistent re-accumulation of tumour-cell positive peritoneal fluid in patients with advanced-stage cancer who are refractory to systemic therapies. This study aimed to characterise the clinical, humanistic and economic burden associated with current rMA management strategies in the UK and Europe.
METHODS: Systematic literature reviews (SLRs) were conducted in accordance with HTA standards to identify published clinical and economic evidence. Additional real-world evidence was retrieved via targeted literature review (all searches to 27 March 2025).
RESULTS: A total of 17 clinical, 38 economic and 74 real-world studies were included. Findings from 39 studies conducted in the UK (15), EU (16) or internationally (8) were prioritised. Current rMA management is palliative and centres on repeated drainage via hospital-based paracentesis or home-based indwelling intraperitoneal catheters (IPCs), providing short-term symptom relief without survival benefit. Due to frequent recurrence, patients often require multiple procedures within short intervals, contributing to reduced quality-of-life (QoL) and increased healthcare resource utilisation. Length of hospital stay (up to 5 days) is a key driver of cost for paracentesis. As an example, a hospital in the UK reported 250,000 GBP in savings by implementing a day-case paracentesis service. Although IPCs are reimbursed in the UK, these interventions entail additional costs such as the IPC placement procedure, fluid collection bottles, nursing services, device replacement, and the management of adverse events (e.g. peritonitis) which occur more frequently with IPCs than paracentesis.
CONCLUSIONS: Management of rMA has remained largely unchanged for approximately 20 years. Given patients' limited life expectancy, improving QoL and minimising hospital time should be prioritised. There remains a significant unmet need for therapies that prolong symptom relief, reduce procedural burden, and carry a manageable safety profile.
METHODS: Systematic literature reviews (SLRs) were conducted in accordance with HTA standards to identify published clinical and economic evidence. Additional real-world evidence was retrieved via targeted literature review (all searches to 27 March 2025).
RESULTS: A total of 17 clinical, 38 economic and 74 real-world studies were included. Findings from 39 studies conducted in the UK (15), EU (16) or internationally (8) were prioritised. Current rMA management is palliative and centres on repeated drainage via hospital-based paracentesis or home-based indwelling intraperitoneal catheters (IPCs), providing short-term symptom relief without survival benefit. Due to frequent recurrence, patients often require multiple procedures within short intervals, contributing to reduced quality-of-life (QoL) and increased healthcare resource utilisation. Length of hospital stay (up to 5 days) is a key driver of cost for paracentesis. As an example, a hospital in the UK reported 250,000 GBP in savings by implementing a day-case paracentesis service. Although IPCs are reimbursed in the UK, these interventions entail additional costs such as the IPC placement procedure, fluid collection bottles, nursing services, device replacement, and the management of adverse events (e.g. peritonitis) which occur more frequently with IPCs than paracentesis.
CONCLUSIONS: Management of rMA has remained largely unchanged for approximately 20 years. Given patients' limited life expectancy, improving QoL and minimising hospital time should be prioritised. There remains a significant unmet need for therapies that prolong symptom relief, reduce procedural burden, and carry a manageable safety profile.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE688
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology