Cost-effectiveness analysis comparing liposomal anthracyclines in the treatment of AIDS-related Kaposi's sarcoma.
Liposomal formulations have been shown to alter the efficacy and toxicity profiles of anthracylines for patients with HIV-related advanced Kaposi's sarcoma (KS). Using decision-analysis models, the costs and cost-effectiveness of the two U.S. Food and Drug Administration (FDA)-approved liposomal formulations of these agents were estimated. Estimates of costs, effectiveness, and cost-effectiveness were derived from clinical trial data of separate, randomized phase III trials of pegylated liposomal doxorubicin (20 mg/m2 every 3 weeks) and liposomal daunorubicin (40 mg/m2 every 2 weeks). Clinical response rates were 59% for pegylated liposomal doxorubicin and 25% for liposomal daunorubicin. Despite higher acquisition costs for pegylated liposomal doxorubicin, total estimated costs of treatment for KS and chemotherapy-related hematologic toxicities were similar ($7,066 U.S. compared with $6,621 U.S. for liposomal daunorubicin). Cost-effectiveness profiles, defined as average costs per responder, favored pegylated liposomal doxorubicin ($11,976 U.S./responder versus $26,483 U.S./responder for liposomal daunorubicin), reflecting the higher reported response rate in the phase III trial. Sensitivity analyses suggested that the costs and cost-effectiveness results would not differ markedly when evaluated over a range of assumptions, including response rate, neutropenia rate, and dosage variations.
Division of Hematology/Oncology, Northwestern University, and VA Chicago Health Care System, Illinois, USA.
C L
CL
Bennett
R M
RM
Golub
T J
TJ
Stinson
D M
DM
Aboulafia
J
J
von Roenn
J
J
Bogner
F D
FD
Goebel
S
S
Stewart
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003630:Daunorubicin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003661:Decision Support Techniques; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D004337:Drug Carriers; D006801:Humans; D008081:Liposomes; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D012680:Sensitivity and Specificity
D000903:Antibiotics, Antineoplastic; D004337:Drug Carriers; D008081:Liposomes; D004317:Doxorubicin; D003630:Daunorubicin