Real-world direct healthcare costs of treating recurrent high-grade serous ovarian cancer with cytotoxic chemotherapy

Abstract

Aim: To describe the direct healthcare costs associated with repeated cytotoxic chemotherapy treatments for recurrent high-grade serous cancer (HGSC) of the ovaries. Patients & methods: Retrospective review of 66 women with recurrent stage III/IV HGSC ovarian cancer treated with repeated lines of cytotoxic chemotherapy in a Canadian University Tertiary Center. Results: Mean cost of treatment of first relapse was CAD$52,227 increasing by 38% for two, and 86% for three or more relapses with median overall survival of 36.0, 50.7 and 42.8 months, respectively. In-hospital care accounted for 71% and chemotherapy drugs accounted for 17% of the total costs. Conclusion: After the third relapse of HGSC, cytotoxic chemotherapy did not prolong survival but was associated with substantially increased healthcare costs.

Rapid Review of Real-World Cost-Effectiveness Analyses of Cancer Interventions in Canada

“…Not only is the age of these patients remarkable, but this patient population is also more likely to have confounding comorbidities; something not common in RCTs with “ideal” study populations. Similarly, other studies included in the review often cited a mean age of over 60 years of age, with common median and mean ages between 60 and 64 [ 17 , 20 , 21 , 23 , 24 , 25 , 29 , 31 , 32 , 33 , 34 , 36 ].…”

“…The most common type of cancer studied was breast cancer; one article focused on screening, while the others focused on various stages and types, for example, early stage, metastatic, or hormone receptor-positive breast cancer [ 18 , 22 , 24 , 26 , 30 , 36 ]. Other studies focused on metastatic colorectal cancer (mCC) [ 25 , 34 ], metastatic renal cell carcinoma (mCRC) [ 31 , 32 ], diffuse large B-cell lymphoma [ 28 , 29 ], bronchioalveolar carcinoma (BCCA) stage IIB/IV [ 20 , 21 ], as well as advanced pancreatic cancer [ 17 ], lung cancer [ 19 ], ovarian cancer stage IIC/IV [ 23 ], low-risk thyroid cancer [ 27 ], prostate cancer [ 33 ], advanced stage Hodgkin’s lymphoma [ 35 ], hepatocellular carcinoma [ 37 ], and metastatic, incurable cancer types [ 38 ].…”

“…A majority (nine) of studies measured effectiveness in both QALYs and LYs [ 17 , 22 , 24 , 25 , 26 , 28 , 32 , 34 , 37 ]. Six of the studies measured effectiveness in only LYs, [ 20 , 21 , 23 , 29 , 31 , 38 ] while four measured in only QALYs [ 18 , 19 , 33 , 35 ]. Two utilized chemotherapy use rates as their measure of effectiveness [ 30 , 36 ], and one utilized rate of recurrence [ 27 ].…”

“…All of the studies included were published between 2012 [ 28 ] and 2022 [ 17 , 22 , 36 ]. While the majority of papers (59%) looked at the real-world cost effectiveness of drugs on cancer, 41% focused on other aspects of cancer care: 7 on screening methods [ 18 , 19 , 23 , 24 , 30 , 36 , 38 ], 1 on preventing recurrence [ 27 ], and 1 on assistive surgery [ 33 ].…”

Real-World Treatment Patterns, Survival, and Costs for Ovarian Cancer in Canada: A Retrospective Cohort Study Using Provincial Administrative Data

“…Cost drivers for both stages were inpatient hospitalizations and cancer clinic visits; however, costs associated with chemotherapy may be underestimated.Although our study was not able to track early-stage OC patients who progressed or patients who relapsed, a recent study of patients with relapsed stage III/IV OC reported a mean cost of CAD $52 227 (2016), with in-hospital care accounting for 71% and chemotherapy for 17% of total costs. 28 Another study in Ontario reported phase-specific costs over a study period of 1997-2007, with a mean per patient cost of OC one year before diagnosis of CAD $2098 (2009) and CAD $29 640 in patients who survived beyond the first year, compared to CAD $46 270 in patients who died during the first year. 29 Comparing our estimated cost to a similar public health care setting in Australia, the mean cost of early OC (stage I or II) was AUD $31 958 compared to AUD $50 945 (2008 costs) in advanced disease (stage III and IV), with a patient follow-up of 2.5 years.…”