Treatments for newly diagnosed advanced ovarian cancer: analysis of survival data and cost-effectiveness evaluation.
The main therapeutic options currently available for patients with newly diagnosed advanced ovarian cancer include: (i) cisplatin-based chemotherapy at conventional doses without paclitaxel, (ii) paclitaxel+cisplatin at conventional doses and (iii) high-dose chemotherapy with autologous hematopoietic rescue. After conducting a literature search to identify large-scale clinical trials based on these three therapeutic modalities, we carried out an analysis of the survival data and evaluated the cost-effectiveness ratio where appropriate. Cost data were obtained from published information. Effectiveness was estimated by determining the values of mean lifetime survival (MLS). Our analysis included a total of 15 clinical trials. The values of MLS were 3.05 years per patient for cisplatin-based chemotherapy at conventional doses without paclitaxel (1931 patients), 2.95 years per patient for chemotherapy with paclitaxel+cisplatin at conventional doses (184 patients) and 5.76 years per patient for high-dose chemotherapy with autologous hematopoietic rescue (53 patients). As compared with cisplatin-based chemotherapy without paclitaxel, high-dose treatments with hematopoietic rescue yielded a significantly better survival. Using cisplatin-based chemotherapy as a reference term, the incremental cost-effectiveness ratio for high-dose treatments was $25641 per life year gained (discounted dollars per discounted life year gained). Sensitivity testing suggested that the ratio remained below $50000 under most circumstances. We conclude that in the treatment of patients with advanced ovarian cancer, high-dose chemotherapy with hematopoietic rescue seems to be more effective and more cost-effective than standard treatments with cisplatin-based regimens at conventional doses.
Messori
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Laboratorio di Farmacoeconomia, Drug Information Center, Pharmaceutical Service, Azienda Ospedaliera Careggi, Florence, Italy.
Trippoli
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Becagli
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Tendi
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D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D019540:Area Under Curve; D016913:Blood Component Transfusion / Q000191:economics*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis / Q000191:economics; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy; D012680:Sensitivity and Specificity; D016019:Survival Analysis