title: Cost effectiveness of paclitaxel/cisplatin compared with cyclophosphamide/cisplatin in the treatment of advanced ovarian cancer in Belgium.
abstract: OBJECTIVE
  To assess the economic impact of two polychemotherapy regimens for patients with advanced ovarian cancer from the perspective of the Belgian health insurance and financing system.
  
  
  METHODS
  An economic evaluation was integrated in an intergroup randomised controlled trial (EORTC 55931) in which patients were randomised to receive the new treatment of paclitaxel and cisplatin or the standard therapy of cyclophosphamide and cisplatin. Data on the use of medical resources were collected prospectively for the 231 European Organization for Research and Treatment of Cancer (EORTC) patients in the trial and costs were valued by using unit prices. The outcome for the economic evaluation was mean survival time as determined by the so-called restricted means method, with the time point of restriction fixed by statistical criteria. A correction of censoring of the cost data collected in the trial was also performed.
  
  
  RESULTS
  The paclitaxel and cisplatin group experienced a statistically significant improvement in mean survival time of 4 months, which was associated with an increase in the average total cost per patient of 6795 euros (EUR; 1998 values), when costs were assessed over the same period as the gain in mean survival time. This corresponds to a point estimate of the incremental cost-effectiveness ratio of EUR20 385 per life-year gained. The impact of uncertainty was assessed by using a bias-corrected and accelerated bootstrap method with 5000 resamples, and the final results of the analysis are expressed in terms of a cost-effectiveness acceptability curve.
  
  
  CONCLUSIONS
  The present economic evaluation has shown that the substitution of paclitaxel for cyclophosphamide in the chemotherapy regimen for women with advanced ovarian cancer leads to a significant improvement in patient survival, which is associated with an increase in costs for the Belgian health insurance system.
authors.affiliation: European Organization for Research and Treatment of Cancer (EORTC) Data Center, Health Economics Unit, bte. 11, Avenue E. Mounier 83, B-1200 Brussels, Belgium.
authors.forename: Niels
authors.initials: N
authors.lastname: Neymark
authors.forename: Thierry
authors.initials: T
authors.lastname: Gorlia
authors.forename: Ines
authors.initials: I
authors.lastname: Adriaenssen
authors.forename: Benoit
authors.initials: B
authors.lastname: Baron
authors.forename: Martine
authors.initials: M
authors.lastname: Piccart
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017239:Paclitaxel / Q000008:administration & dosage
chemical_list: D003520:Cyclophosphamide; D017239:Paclitaxel; D002945:Cisplatin