title: Cost-utility analysis of paclitaxel in combination with cisplatin for patients with advanced ovarian cancer.
abstract: The standard treatment for patients with advanced ovarian cancer (AOC) has been cyclophosphamide and cisplatin (CP). Recently, the results of a large randomized comparative trial demonstrated that the combination of paclitaxel and cisplatin (TP) provided a progression-free survival benefit of 5 months. In this study, a cost-utility analysis was performed from a Canadian health care system perspective to estimate the incremental cost-effectiveness of the TP combination. Twelve AOC patients who received treatment with TP were matched for age and disease stage on a 1-to-2 basis with a CP control. Total hospital resource consumption was then collected for all patients. Treatment preferences were estimated from a cohort of 20 patients and 40 healthy female volunteers using the time trade-off technique. The outcomes were then generated through a decision-analytic model. First-line treatment costs with TP were approximately fourfold greater on a per-cycle basis than the CP alternative (Can$1911 vs Can$459). When progression-free survival benefit and patient treatment preferences were incorporated into the analysis, the results of the decision model revealed an incremental cost between Can$12,000 and Can$24,000 per quality-adjusted progression-free year with the TP protocol. Even though the TP combination has a considerably higher drug acquisition cost, the results of the current analysis suggest that this new chemotherapy regimen does provide patients with substantial quality-adjusted progression-free survival benefit at a reasonable cost to the Canadian health care system.
authors.affiliation: Department of Pharmacy, Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ortega
authors.forename: G
authors.initials: G
authors.lastname: Dranitsaris
authors.forename: J
authors.initials: J
authors.lastname: Sturgeon
authors.forename: H
authors.initials: H
authors.lastname: Sutherland
authors.forename: A
authors.initials: A
authors.lastname: Oza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002170:Canada; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D002945:Cisplatin