Intraperitoneal cisplatin and paclitaxel versus intravenous carboplatin and paclitaxel chemotherapy for Stage III ovarian cancer: a cost-effectiveness analysis.
OBJECTIVE
To evaluate the cost-effectiveness of intraperitoneal cisplatin and paclitaxel chemotherapy as front-line treatment for patients with Stage III epithelial ovarian cancer following optimal primary cytoreductive surgery.


METHODS
Based on Gynecologic Oncology Group protocols #172 and #158, a decision analysis model was created to compare two treatment strategies for patients with optimal residual disease Stage III ovarian cancer: (1) inpatient intravenous paclitaxel (24 h) and intraperitoneal cisplatin plus outpatient intraperitoneal paclitaxel chemotherapy (IP/IV), and (2) outpatient intravenous paclitaxel (3 h) and carboplatin chemotherapy (IV/IV). The cost-effectiveness of each strategy was evaluated from the perspective of society.


RESULTS
Cost-effectiveness analysis revealed that the strategy of IP/IV chemotherapy had an overall cost per patient of $39,861 and effectiveness of 5.16 QALYs compared to $18,822 and 4.59 QALYs for IV/IV chemotherapy. The IP/IV chemotherapy strategy was associated with an additional 0.56 QALYs at an incremental cost of $21,039. The incremental C/E ratio for IP/IV chemotherapy was $37,454/QALY. Inpatient treatment accounted for 43.2% of the cost of IP/IV chemotherapy. Sensitivity analysis testing confirmed the robustness of the model.


CONCLUSIONS
In this model, IP/IV chemotherapy was associated with a modest extension in quality-adjusted survival time but was also more costly than IV/IV chemotherapy. On balance, the IP/IV strategy can be considered a good healthcare value. However, these data also suggest that efforts to reduce the cost of IP/IV chemotherapy, such as through development of an ambulatory regimen with equivalent therapeutic efficacy but an improved toxicity profile, would improve the overall value of this adjuvant treatment program.
Bristow
Robert E
RE
The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. rbristo@jhmi.edu
Santillan
Antonio
A
Salani
Ritu
R
Diaz-Montes
Teresa P
TP
Giuntoli
Robert L
RL
Meisner
Benjamin C
BC
Armstrong
Deborah K
DK
Frick
Kevin D
KD
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D018803:Models, Economic; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics
D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin