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: David E Cohn, Jason C Barnett, Lari Wenzel, Bradley J Monk, Robert A Burger, J Michael Straughn Jr, Evan R Myers, Laura J Havrilesky
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 136 Issue 2 Pg. 293-9 (Feb 2015) ISSN: 1095-6859 [Electronic] United States
• PMID: 25449568 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

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

Topics

• Antibodies, Monoclonal, Humanized (administration & dosage, economics)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bevacizumab
• Carboplatin (administration & dosage, economics)
• Clinical Trials as Topic
• Cost-Benefit Analysis
• Disease-Free Survival
• Female
• Humans
• Markov Chains
• Models, Economic
• Neoplasm Staging
• Ovarian Neoplasms (drug therapy, economics, pathology)
• Paclitaxel (administration & dosage, economics)
• Prospective Studies
• Quality of Life
• Survival Analysis
• United States