title: A cost-utility analysis of NRG Oncology/Gynecologic Oncology Group Protocol 218: incorporating prospectively collected quality-of-life scores in an economic model of treatment of ovarian cancer.
abstract: OBJECTIVE
  To estimate quality-of-life (QOL)-adjusted cost-utility with addition of bevacizumab (B) to intravenous paclitaxel/carboplatin (PC) for primary treatment of advanced-stage epithelial ovarian cancer.
  
  
  METHODS
  A modified Markov state transition model of 3 regimens evaluated in GOG 218 (PC, PC+concurrent B [PCB], and PCB+maintenance B [PCB+B]) was populated by prospectively collected survival, adverse event, and QOL data from GOG 218. Progression-free survival (PFS) and overall survival (OS) were modeled using primary event data. Costs of grade 4 hypertension, grade 3-5 bowel events, and growth factor support were incorporated. QOL scores were converted to utilities and incorporated into the model. Monte Carlo probabilistic sensitivity analysis was performed to account for uncertainty in estimates.
  
  
  RESULTS
  PC was the least expensive ($4044) and least effective (mean 1.1 quality-adjusted progression-free years [QA-PFY]) regimen. PCB ($43,703 and 1.13 QA-PFY) was dominated by a combination of PC and PCB+B. PCB+B ($122,700 and 1.25 QA-PFY) was the most expensive regimen with an incremental cost-effectiveness ratio of $792,380/QA-PFY compared to PC. In a model not incorporating QOL, the incremental cost-effectiveness ratio (ICER) of PCB+B was $632,571/PFY compared to PC.
  
  
  CONCLUSIONS
  In this cost-utility model, incorporation of QOL into an analysis of GOG 218 led to less favorable ICER (by >$150,000/QA-PFY) in regimens containing B compared with those that do not include B. Continued investigation of populations with ovarian cancer in whom the efficacy of treatment with bevacizumab is expected to be increased (or in whom QOL is expected to increase with use) is critical.
authors.affiliation: The Ohio State University, Columbus, OH, USA. Electronic address: david.cohn@osumc.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: San Antonio Military Medical Center, Ft. Sam Houston, TX, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
authors.affiliation: University of California, Irvine, Irvine, CA, USA.
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
authors.affiliation: University of Arizona Cancer Center and Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Burger
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Straughn
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D000068258:Bevacizumab; D016190:Carboplatin / Q000008:administration & dosage / Q000191:economics; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D016019:Survival Analysis; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D016190:Carboplatin; D017239:Paclitaxel
keywords: Cost–utility analysis; GOG Oncology Group; NRG Oncology; Ovarian cancer; Quality-of-life