Consolidation paclitaxel is more cost-effective than bevacizumab following upfront treatment of advanced epithelial ovarian cancer.

Abstract

INTRODUCTION:

Randomized trials have demonstrated significant improvements in progression-free survival (PFS) with consolidation paclitaxel (P) and bevacizumab (B) following cytoreduction and adjuvant carboplatin/paclitaxel (CP) for advanced epithelial ovarian cancer (EOC). We sought to evaluate the cost-effectiveness (C/E) of these consolidation strategies.

METHODS:

A decision model was developed based on Gynecologic Oncology Group (GOG) protocols #178 and #218. Arm 1 is 6 cycles of CP. Arm 2 is 6 cycles of CP followed by 12 cycles of P (CP+P). Arm 3 is 1 cycle of CP, 5 cycles of CPB, and 16 cycles of B (CPB+B). Parameters include PFS, overall survival (OS), cost, complications (neuropathy for P and bowel perforation for B), and quality-of-life utility values. Sensitivity analyses were performed.

RESULTS:

The incremental cost-effectiveness ratio (ICER) for CT+T is $13,402/quality adjusted life year (QALY) gained compared to CP. For CPB+B compared to CP, the ICER is $326,530/QALY. When compared simultaneously, CPB+B is dominated, i.e. is more costly and less effective than CP+P. Results were robust to parameter variation. At a willingness to pay threshold of $100,000/QALY, CP+P was the preferred option throughout most of the decision space. Sensitivity analyses suggest that CPB+B would become the preferred option if it were to improve OS by 6.1 years over CP+P.

CONCLUSIONS:

In this model, B consolidation for advanced EOC was associated with a modest improvement in effectiveness that is less than that with P consolidation and more costly. A statistically significant improvement in survival may improve the value of B consolidation.

• Authors: Jamie L Lesnock, Coreen Farris, Thomas C Krivak, Kenneth J Smith, Maurie Markman
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 122 Issue 3 Pg. 473-8 (Sep 2011) ISSN: 1095-6859 [Electronic] United States
• PMID: 21665250 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Bevacizumab
• Carboplatin
• Paclitaxel

Topics

• Antibodies, Monoclonal (administration & dosage, adverse effects, economics)
• Antibodies, Monoclonal, Humanized
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, economics, therapeutic use)
• Bevacizumab
• Carboplatin (administration & dosage, adverse effects)
• Carcinoma, Ovarian Epithelial
• Combined Modality Therapy
• Cost-Benefit Analysis
• Decision Support Techniques
• Drug Costs
• Female
• Humans
• Markov Chains
• Neoplasm Staging
• Neoplasms, Glandular and Epithelial (drug therapy, economics, pathology, surgery)
• Ovarian Neoplasms (drug therapy, economics, pathology, surgery)
• Paclitaxel (administration & dosage, adverse effects, economics)
• Randomized Controlled Trials as Topic (economics, methods)