Analysis of the cost effectiveness of concurrent cisplatin-based chemoradiation in cervical cancer: implications from five randomized trials.
OBJECTIVE
Five recent phase III trials provide strong evidence that a new alternative therapy, cisplatin-based chemoradiation, is more effective than standard therapy using radiation alone in the treatment of advanced cervical cancer. We conducted a pharmacoeconomic analysis to determine whether the alternative cisplatin-based chemoradiation is cost effective as compared with standard therapy using radiation alone.


METHODS
Using an economic model, we applied costs to resource utilization data derived from the cisplatin-based chemoradiation arms of these five randomized trials. We examined the cisplatin-based chemoradiation benefits in terms of increased median survival time. Incremental costs were divided by difference in survival to determine the cost per patient benefited. Incremental cost per year of life gained (IC/YLG) was calculated based on both published and estimated survival figures.


RESULTS
Cost per year of life gained for cisplatin-based chemoradiation regimens varied from $2384 to $28,770 based on published survival and from $308 to $3712 based on estimated survival. Variations in regimen cost were largely dependent on treatment setting. Administration costs per patient for cisplatin and fluorouracil in the inpatient setting were $8839 compared with $3590 in the outpatient setting.


CONCLUSIONS
The increased median survival cost per year of life gained with cisplatin-based chemoradiation (inpatient and outpatient settings) adds a substantial benefit at an acceptable cost compared with radiation therapy alone.
Rose
P G
PG
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Case Western Reserve University, OH 44106, USA.
Lappas
P T
PT
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D005260:Female; D006801:Humans; D008017:Life Expectancy; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D018803:Models, Economic; D011379:Prognosis; D011878:Radiotherapy / Q000191:economics*; D016019:Survival Analysis
D000970:Antineoplastic Agents; D002945:Cisplatin