Pharmacoeconomic profile of paclitaxel as a first-line treatment for patients with advanced ovarian carcinoma: A lifetime cost-effectiveness analysis

Abstract

BACKGROUND. Analysis of published survival curves has recently been proposed as a method for conducting incremental cost-effectiveness analysis in which two treatments are compared with each other in terms of cost per year of life gained. In patients with advanced ovarian carcinoma, the combination of paclitaxel and cisplatin has been reported to improve survival more significantly than standard therapy with cyclophosphamide and cisplatin. However, the high cost of paclitaxel indicates a need for an evaluation of the pharmacoeconomic profile of these treatments.

Retrospective survival analysis and cost-effectiveness evaluation of second allogeneic bone marrow transplantation in patients with acute leukemia

“…In this model, the survival analysis for the 2BMT group and for the chemotherapy group was based on a lifetime approach [9][10][11][12][13][14][15][16][17][18][19][20][21][22] that covered the entire post-relapse life expectancy of the patients; accordingly, all survival data were expressed as a combination of measured survival and predicted (or extrapolated) survival. This lifetime methodology that considers measured survival plus predicted survival is recommended by current guidelines for cost-effectiveness analysis.…”

“…23 In Model 2, the survival pattern for the two treatment options was quantified by determining the values of mean lifetime survival per patient (MLS) according to the Gom-pertz technique. [9][10][11][12][13][14][15][16][17][18][19][20] This latter technique employs an extrapolation to infinity of the survival curve for calculating both the area under the survival curve (AUC) and the corresponding MLS. 15 Cost data were obtained from published information and were introduced in a simplified analysis that estimated the incremental cost per patient between the two treatment options.…”

“…In the field of oncology, lifetime cost-effectiveness analyses have already examined adjuvant chemotherapy with CMF vs no chemotherapy in node-positive breast cancer ($1500 per life year gained), 14 adjuvant intraportal chemotherapy vs no chemotherapy in colon cancer ($1200 per life year gained), 11 adjuvant interferon vs no adjuvant therapy in high-risk resected melanoma ($16 000 per life year gained), 12 autologous bone marrow transplantation vs chemotherapy in chemosensitive relapsed non-Hodgkin's lymphoma ($9200 per life year gained), 13 paclitaxel + cisplatin vs cisplatin + cyclophosphamide as first-line treatment of advanced ovarian cancer (about $19 000 per life year gained), 10,16 second bone marrow transplantation vs standard salvage therapy in nonHodgkin's lymphoma (about $11 000 per life year gained), 17 interferon vs cytotoxic agents in chronic myelogenous leukemia (from $26 000 to $123 000 per qualityadjusted life year gained); 21,22,32,33 the present study, therefore, covered a topic on which no specific cost-effectiveness data were available. In recent times there has been an increasing interest in assessing survival gains using lifetime models; 40 in this context, our study has provided original information on the lifetime gains that can result from using 2BMT in acute leukemia patients.…”

Cost Effectiveness of Chemotherapeutic Agents and Targeted Biologics in Ovarian Cancer: A Systematic Review

“…From 1996 to 1998 a series of cost-effectiveness evaluations compared the standard cisplatin-cyclophosphamide with cisplatin-paclitaxel for treatment of advanced ovarian cancer patients [21][22][23][24][25]. These studies were conducted in various countries and from varying healthcare perspectives.…”

“…However, only 19 studies included all of the above-mentioned costs in their analyses. A mix of micro-costing and gross-costing approaches were used with cost data estimated from fee schedules [22-24, 26, 27, 34, 40, 41, 45, 46], hospitals [22-25, 28, 44, 47, 48], Medicare reimbursement data [30-32, 38, 39, 42, 45], secondary databases (e.g., Agency for Healthcare Research and QualityHealthcare Cost and Utilization Project) [29,30,32,39,43], and literature [21,34,37,46,55]. Similarly, drug costs were obtained from various sources like hospitals [22,23,25,29,37,48], formularies or fee schedules [24,26,34,40,41,43,46], Medicare reimbursement data [30, 31, 33, 37-39, 42, 45], or average wholesale prices [28,39,44,47].…”