title: Trabectedin in the treatment of metastatic soft tissue sarcoma: cost-effectiveness, cost-utility and value of information.
abstract: BACKGROUND
  to assess the cost-effectiveness of trabectedin compared with end-stage treatment (EST) after failure with anthracycline and/or ifosfamide in metastatic soft tissue sarcoma (mSTS).
  
  
  METHODS
  analysis was carried out using a probabilistic Markov model with trabectedin → EST and EST arms, three health states (stable disease, progressive disease and death) and a lifetime perspective (3% annual discount rate). Finnish resources (drugs, mSTS, adverse events and travelling) and costs (year 2008) were used. Efficacy was based on an indirect comparison of the STS-201 and European Organisation for Research and Treatment of Cancer trials. QLQ-C30 scale scores were mapped to 15D, Short Form 6D and EuroQol 5D utilities. The outcome measures were the cost-effectiveness acceptability frontier, incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) gained and the expected value of perfect information (EVPI).
  
  
  RESULTS
  trabectedin → EST was associated with 14.0 (95% confidence interval 9.1-19.2) months longer survival, €36 778 higher costs (€32 816 using hospital price for trabectedin) and €31 590 (€28 192) incremental cost per LYG with an EVPI of €3008 (€3188) compared with EST. With a threshold of €50 000 per LYG, trabectedin → EST had 98.5% (98.2%) probability of being cost-effective. The incremental cost per QALY gained with trabectedin → EST was €42 633-47 735 (€37 992-42 819) compared with EST. The results were relatively insensitive to changes.
  
  
  CONCLUSIONS
  trabectedin is a potentially cost-effective treatment of mSTS patients.
authors.affiliation: ESiOR Oy, Kuopio, Finland. Electronic address: erkki.soini@esior.fi.
authors.forename: E J O
authors.initials: EJO
authors.lastname: Soini
authors.affiliation: PharmaMar, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: García San Andrés
authors.affiliation: International Comprehensive Cancer Centre Docrates, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Joensuu
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004149:Dioxoles / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008390:Markov Chains; D015233:Models, Statistical; D009362:Neoplasm Metastasis; D012509:Sarcoma / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D044005:Tetrahydroisoquinolines / Q000191:economics / Q000627:therapeutic use*; D000077606:Trabectedin
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D044005:Tetrahydroisoquinolines; D000077606:Trabectedin