Comparative Cost-Effectiveness of Paclitaxel-Cisplatin (TP) vs Cyclophosphamide-Cisplatin (CP) in Women with Advanced Epithelial Ovarian Cancer: Results from a Randomized Trial.

Jason Lee, MD
OncoLink Assistant Editor
Last Modified: May 23, 2000

Presenter: Hugh Walker
Affiliation: Queens Univ, Kingston, NC, Canada

Background:

Postoperative paclitaxel and cisplatin (TP) chemotherapy improves survival compared with cyclophosphamide and cisplatin (CP) in patients with advanced ovarian cancer
The combination of TP is considerably more expensive than CP, and may raise concerns regarding increased health expenditures
The National Cancer Institute of Canada performed a cost-effectiveness analysis of the two chemotherapy regimens to address these concerns

Materials and Methods:

A multinational phase III randomized trial compared postoperative TP vs. CP in 680 patients with advanced ovarian cancer across Canadian and European treatment centers
A cost-effectiveness analysis was performed on 160 patients enrolled in the Canadian centers
Medical resource consumption for outpatient care and hospitalizations was itemized for each patient
The unit costs for each medical resource were estimated from data from academic medical centers, and reported in US dollars
Total costs were aggregated for each patient from the time of randomization to the time of death, but excluded costs of second-line therapy
Cost-effectiveness was determined by dividing the incremental costs of TP vs. CP by the incremental gains in median progression-free survival (PFS) and overall survival (OS)

Results:

The results of the randomized trial demonstrated an improvement with TP compared with CP with respect to median PFS (17.5 mos vs. 10.1 mos) and OS (36.8 mos vs. 25.6 mos) with TP compared with CP
The incremental benefit in PFS was estimated to be 7.4 mos and the incremental benefit in OS was 11.2 mos
The average cost per patient treated with TP was $30,774 compared with an average cost of $18,515 using CP
The increase in treatment costs was almost entirely attributable to the higher cost of paclitaxel compared with cyclophosphamide ($8000 vs. $100), but hospitalization and ambulatory care costs were also higher
The cost-effectiveness of TP per year of PFS was $21,321 and per year of OS was $13,135

Authors' Conclusions

The results of this analysis suggest that postoperative TP is a cost-effective treatment in patients with advanced ovarian cancer
The cost-effectiveness of TP per life-year gained is $13,135, which is well-below the commonly quoted threshold of $50,000 for cost- effective care

Clinical/Scientific Implications:

Based on this economic model, the increased costs of TP are justified by the substantial increase in PFS and OS.