A cost-effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian cancer.
OBJECTIVE
The majority of patients with advanced epithelial ovarian cancer (EOC) will experience a recurrence after primary chemotherapy and receive second-line chemotherapy. Patients who have a disease-free interval >6 months (platinum-sensitive) will often receive multiple chemotherapy regimens. Therefore, our goal was to assess the effectiveness and medical costs of chemotherapy for platinum-sensitive patients with advanced EOC.


METHODS
A decision analysis model compared several chemotherapeutic strategies in a hypothetical cohort of 10,000 platinum-sensitive EOC patients with recurrent disease: (a) best supportive care (BSC); (b) second-line monotherapy; (c) second-line combination therapy; (d) third-line chemotherapy after disease progression on second-line monotherapy or combination therapy; (e) fourth-line chemotherapy after disease progression on second- and third-line chemotherapy.


RESULTS
BSC and second-line therapies were cost-effective strategies. The cost-effectiveness ratios ranged from $2896 for second-line monotherapy to $4914 for fourth-line previous monotherapy. Compared to BSC, second-line monotherapy gained an additional 8 months of overall survival (OS) with a favorable incremental cost-effectiveness ratio (ICER) of $24,228 per life year saved (LYS). The ICER for second-line combination therapy compared to second-line monotherapy was also favorable ($46,068 per LYS). Although third- and fourth-line chemotherapy provided small improvements in OS, they were dominated by other strategies or had an unfavorable ICER (>$50,000 per LYS).


CONCLUSIONS
Second-line chemotherapy is cost-effective for patients with platinum-sensitive recurrent EOC. Due to minimal improvements in overall survival, third- and fourth-line chemotherapy are not cost-effective strategies.
Case
Ashley S
AS
University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, USA. casea@wudosis.wustl.edu
Rocconi
Rodney P
RP
Partridge
Edward E
EE
Straughn
J Michael
JM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000191:economics*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D005260:Female; D006801:Humans; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000191:economics; D009944:Organoplatinum Compounds / Q000008:administration & dosage* / Q000191:economics*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics
D001952:Bridged-Ring Compounds; D009944:Organoplatinum Compounds; D043823:Taxoids; C080625:taxane