Cost-minimization analysis of pegylated liposomal doxorubicin versus topotecan for the treatment of ovarian cancer in Italy.
BACKGROUND
Ovarian cancer is the most prevalent gynecologic cancer in women. Unfortunately for patients whose cancer is resistant to first-line therapies (platinum and paclitaxel), only a few second-line regimens have both significant efficacy and minimal treatment-related toxicity. Furthermore, the use of these agents increases treatment costs due to adverse events (AEs) related to tolerability and toxicity.


OBJECTIVE
The aim of the present study was to assess the comparative patient-specific treatment costs associated with 2 second-line therapies, both benchmark therapies used to treat ovarian cancer patients in Italy: pegylated liposomal doxorubicin (PLD) and topotecan, which appear to have similar efficacy but different tolerability and toxicity profiles.


METHODS
A cost-minimization analysis was performed in line with the point of view of Italy's National Health Service. Data on treatment efficacy and the number and types of AEs associated with drug toxicity were taken from a recent Phase III clinical trial comparing PLD with topotecan for the treatment of ovarian cancer. Resource-use estimates for each AE were based on the opinions of a panel of experts (Delphi method). Unit costs were drawn from national sources and a sensitivity analysis was performed.


RESULTS
The mean total per-patient cost in the PLD arm was 8812 euro(minimum, 8281 euro; maximum, 9314 euro) compared with 15,788 euro in the topotecan arm (minimum 12,014 euro; maximum 18,847 euro). The higher acquisition cost of PLD offset the higher cost of managing the AEs related to treatment with topotecan.


CONCLUSIONS
The present analysis suggested the net cost-saving capability of PLD compared with topotecan. PLD required fewer ambulatory care-center visits for treatment administration and was associated with fewer severe AEs than topotecan.
Capri
Stefano
S
ISIS Research, Milan, Italy. s.capri@iol.it
Cattaneo
Giulio
G
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy / Q000453:epidemiology; D008081:Liposomes; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D011092:Polyethylene Glycols; D016032:Randomized Controlled Trials as Topic; D019772:Topotecan / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D008081:Liposomes; D011092:Polyethylene Glycols; D019772:Topotecan; D004317:Doxorubicin