title: Economic and policy implications of adopting paclitaxel as first-line therapy for advanced ovarian cancer: an Ontario perspective.
abstract: OBJECTIVE
  To determine the potential economic and policy implications that result from incorporating paclitaxel into first-line therapy for stage 3 and 4 ovarian cancer patients in the province of Ontario, Canada.
  
  
  METHODS
  A cost-effectiveness analysis was conducted to compare cisplatin/cyclophosphamide (CC), a standard therapy, with cisplatin/paclitaxel (CT). Based on survival curves from a clinical trial, mean costs and survival were calculated. Sensitivity analyses were conducted based on altering the duration of paclitaxel infusion, discount rates, and efficacy of paclitaxel.
  
  
  RESULTS
  The mean survival duration is prolonged from 2.06 years with the standard therapy to 2.44 years with the paclitaxel combination. The paclitaxel therapy is more expensive, with a mean cost of $17,469 (Canadian) per patient treated with CT compared with $5,228 per patient with CC. The incremental cost-effectiveness ratio is $32,213 per year gained. Sensitivity analyses show that the conclusions remain unchanged. The use of CT as first-line treatment for advanced ovarian cancer patients in Ontario requires an additional $9 million per year over and above the present costs to treat this patient population.
  
  
  CONCLUSIONS
  Although paclitaxel-based therapy prolongs survival, it comes at an increased cost. It may not be possible to fund paclitaxel treatment using resources presently allocated to first-line chemotherapy for advanced ovarian cancer. The policy implications for absorbing the cost of paclitaxel in the context of a publicly funded health care system are discussed.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada. lelit@lhsc.on.ca
authors.forename: L M
authors.initials: LM
authors.lastname: Elit
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.forename: M N
authors.initials: MN
authors.lastname: Levine
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D009864:Ontario; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017239:Paclitaxel / Q000191:economics* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel