title: Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer.
abstract: OBJECTIVE
  To determine the potential economic impact of a paclitaxel drug shortage in patients with newly diagnosed, untreated ovarian cancer.
  
  
  METHODS
  A modified Markov state transition model with a 6 cycle time horizon compared two scenarios: (1) Standard treatment (STD): paclitaxel 175 mg/m2/carboplatin AUC 5 × 6 cycles; (2) Paclitaxel drug shortage (DS): docetaxel 75 mg/m2/carboplatin AUC 5 × 6 cycles. Adverse events, quality of life, and costs of chemotherapy, neuropathy, febrile neutropenia, and anemia were incorporated. Key assumptions: (1) Costs and consequences were assigned only to grade 2+ neuropathy, febrile neutropenia, and grade 3-4 anemia; (2) Grade 2+ neuropathy prompted a switch from paclitaxel/carboplatin to docetaxel/carboplatin or from docetaxel/carboplatin to carboplatin alone; (3) Febrile neutropenia resulted in inpatient hospitalization followed by G-CSF prophylaxis.
  
  
  RESULTS
  The mean cost of 6 cycles of chemotherapy was $4939 in the STD and $16,107 in the DS scenario, for a cost difference of $11,168 per patient over 6 cycles of treatment. STD was the dominant strategy (less expensive and more effective than the drug shortage scenario). In sensitivity analysis, DS was more costly over a wide range of clinical estimates in each arm. A drug shortage that affects approximately 50% of women initiating chemotherapy is expected to impact 779 women and cost third party payers an additional $8,699,872 monthly.
  
  
  CONCLUSIONS
  Our model indicates that chemotherapy drug shortages can have a significant negative impact on the average cost of primary treatment for ovarian cancer and have the potential to negatively impact health system costs.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center; Duke Cancer Institute, Durham, NC 27710, USA. havri001@mc.duke.edu
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Craig F
authors.initials: CF
authors.lastname: Garfield
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000191:economics* / Q000600:supply & distribution*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage / Q000191:economics; D000077143:Docetaxel; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008390:Markov Chains; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics* / Q000600:supply & distribution*; D011788:Quality of Life; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D014481:United States
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel