title: Cost-effectiveness analysis of dose-dense versus standard intravenous chemotherapy for ovarian cancer: An economic analysis of results from the Gynecologic Oncology Group protocol 262 randomized controlled trial.
abstract: OBJECTIVE
  To determine the cost-effectiveness of dose-dense versus standard intravenous adjuvant chemotherapy for ovarian cancer using results from the no-bevacizumab cohort of the Gynecologic Oncology Group protocol 262 (GOG-262) randomized controlled trial, which reported a smaller absolute progression-free survival (PFS) benefit than the prior Japanese trial.
  
  
  METHODS
  A three-state Markov decision model from a healthcare system perspective with a 21day cycle length and 28month time-horizon was used to calculate incremental cost-effectiveness ratio (ICER) values per progression-free life-year saved (PFLYS) using results from GOG-262. Costs of chemotherapy, complications, and surveillance were from Medicare or institutional data. PFS, discontinuation, and complication rates were from GOG-262. Time-dependent transition probabilities and within-cycle corrections were used. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  The model produces standard and dose-dense cohorts with 84.3% and 68.3% progression event proportions at 28months, matching GOG-262 rates at the trial's median follow-up. With a median PFS of 10.3months after standard chemotherapy and a hazard ratio for progression of 0.62 after dose-dense therapy, the ICER for dose-dense chemotherapy is $8074.25 (95% confidence interval: $7615.97-$10,207.16) per PFLYS. ICER estimates are sensitive only to the hazard ratio estimate but do not exceed $100,000 per PFLYS. 99.8% of ICER estimates met a more stringent willingness-to-pay of $50,000 per PFLYS. The willingness-to-pay value at which there is a 90% probability of dose-dense treatment being cost-effective is $12,000 per PFLYS.
  
  
  CONCLUSIONS
  Dose-dense adjuvant chemotherapy is robustly cost-effective for advanced ovarian cancer from a healthcare system perspective based on results from GOG-262.
authors.affiliation: Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. Electronic address: brandon.seagle@northwestern.edu.
authors.forename: Brandon-Luke L
authors.initials: BL
authors.lastname: Seagle
authors.affiliation: Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Shahabi
mesh_terms: D061605:Administration, Intravenous; D000740:Anemia / Q000139:chemically induced / Q000191:economics / Q000628:therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D000069585:Filgrastim / Q000191:economics / Q000627:therapeutic use; D006401:Hematologic Agents / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000191:economics; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics; D017239:Paclitaxel / Q000008:administration & dosage* / Q000191:economics; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000191:economics; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D006401:Hematologic Agents; D017239:Paclitaxel; D000069585:Filgrastim