Gestational trophoblastic neoplasia (GTN) is a rare malignancy affecting patients of reproductive age and occurring as an abnormal proliferation of trophoblastic tissue [1,2]. Epidemiologic studies report a wide geographic variation in incidence of molar pregnancies and choriocarcinoma, with North American reported rates of 1 in 1000 and 1 in 20–40,000 for molar pregnancy and choriocarcinoma respectively [2,3]. Patients at age ‘extremes’ are at increased risk of developing GTN, with risk increasing after age 35 [1]. Overall, GTN is a highly curable malignancy with cure rates approaching 95–100% if optimally managed [1,4].

The International Federation of Obstetrics and Gynecology (FIGO) scoring system uses eight prognostic factors to classify GTN patients into low-risk or high-risk categories that determine the type of standard of care chemotherapy [1]. Low-risk patients (FIGO score 0–6) are treated with single agent chemotherapy such as Dactinomycin or Methotrexate, whereas high-risk (FIGO score 7–12) and ultra-high-risk patients (FIGO score 13+) receive multi-agent chemotherapy [1,2]. For low-risk non-metastatic GTN, hysterectomy was recently described as a treatment strategy to avoid or minimize chemotherapy treatment in patients who do not desire fertility [5,6]. Cure rates with hysterectomy alone for non-metastatic low-risk disease were estimated at 75–83% in retrospective cohort studies, with fewer chemotherapy cycles when adjuvant chemotherapy was required [5,6]. The two treatment modalities have different trade-offs, with chemotherapy alone requiring more visits and a longer duration of treatment, while surgical management provides a faster but more invasive treatment with risks of surgical complications. Additionally, patients with hysterectomy may potentially still require chemotherapy postoperatively to achieve similar rates of cure. There is no current cost literature comparing these two treatment strategies, and their impact on patient and disease outcomes. Accordingly, the objective of this study was to create a decision analysis model comparing the cost-effectiveness of hysterectomy with single agent chemotherapy for low-risk non-metastatic GTN in patients who have completed childbearing.