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Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer
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 Title & Authors
Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer
Luealon, Phanida; Khempech, Nipon; Vasuratna, Apichai; Hanvoravongchai, Piya; Havanond, Piyalamporn;
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 Abstract
Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable`s impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.
 Keywords
Cost-effectiveness analysis;chemotherapy;best supportive care;recurrent-platinum ovarian cancer;
 Language
English
 Cited by
 References
1.
Carter JR, Chen MD, Fowler JM, et al (1997). The effect of prolonged cycles of chemotherapy on quality of life in gynaecologic cancer patients. J Obstet Gynaecol Res, 23, 197-203 crossref(new window)

2.
Berek JS, Friedlander M, Hacker NF (2010). Epithelial ovarian, fallopian tube, and peritoneal cancer. In 'Berek & Hacker's Gynecologic Oncology', Eds Berek J S and Hacker N F. Lippincott Williams & Wilkins, Philadelphia, 443-508.

3.
Arimoto T, Nakagawa S, Oda K, et al (2012). Second-line chemotherapy with docetaxel and carboplatin in paclitaxel and platinum-pretreated ovarian, fallopian tube, and peritoneal cancer. Med Oncol, 29, 1253-4. crossref(new window)

4.
Tangjitgamol S, See HT, Manusirivithaya S, et al (2004). Thirdline chemotherapy in platinum- and paclitaxel-resistant ovarian, fallopian tube, and primary peritoneal carcinoma patients. Int J Gynecol Cancer, 14, 804-14. crossref(new window)

5.
Doyle C, Stockler M, Pintilie M, et al (1997). Resource implications of palliative chemotherapy for ovarian cancer. J Clin Oncol, 15, 1000-7. crossref(new window)

6.
Donovan KA, Greene PG, Shuster JL, et al (2002). Treatment preferences in recurrent ovarian cancer. Gynecol Oncol, 86, 200-11. crossref(new window)

7.
Fleming G, Seidman J, Lengyel E (2013). Epithelial ovarian cancer. in 'principles and practice of gynecologic oncology', Eds Barakat R R, Berchuck A, Markan M, et al. Lippincott Williams & Wilkins, Philadephia, 757-847

8.
Srisuttayasathien M, Khemapech N (2013). Quality of life in ovarian cancer patients choosing to receive salvage chemotherapy or palliative treatment. Asian Pac J Cancer Prev, 14, 7669-74 crossref(new window)

9.
Mutch D G, Orlando M, Goss T, et al (2007). Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol, 25, 2811-8 crossref(new window)

10.
Vergote I, Finkler N, del Campo J, et al (2009). Phase 3 randomised study of canfosfamide (Telcyta, TLK286) versus pegylated liposomal doxorubicin or topotecan as third-line therapy in patients with platinum-refractory or -resistant ovarian cancer. Eur J Cancer, 45, 2324-32. crossref(new window)

11.
Hanker L C, Loibl S, Burchardi N, et al (2012). The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol, 23, 2605-12. crossref(new window)

12.
Nishio S, Katsumata N, Matsumoto K, et al (2009). Usefulness of third-line chemotherapy for women with recurrent ovarian, fallopian tube, and primary peritoneal cancer who receive platinum/taxane regimens as first-line therapy. J Cancer Res Clin Oncol, 135, 551-7. crossref(new window)

13.
Chaikledkaew U (2009). Guideline for estimate life expectancy and transitional probability. (in Thai). In 'Thai National Health Technology Assessment Guidelines', Eds Chaikledkaew U, Teerawatananon Y, Kongpittayachai S, et al. Chulalongkorn University Press, Bangkok, 315-45.

14.
Patnaik A, Doyle C, Oza AM (1998). Palliative therapy in advanced ovarian cancer: balancing patient expectations, quality of life and cost. Anticancer Drugs, 9, 869-78. crossref(new window)

15.
NCCN (2012). Epithelial ovarian cancer/fallopian tube cancer/primary peritoneal cancer.

16.
Rocconi RP, Case AS, Straughn JM, et al (2006). Role of chemotherapy for patients with recurrent platinum-resistant advanced epithelial ovarian cancer: A cost-effectiveness analysis. Cancer, 107, 536-43. crossref(new window)

17.
Wilailak S, Lertkhachonsuk AA, Lohacharoenvanich N, et al (2011). Quality of life in gynecologic cancer survivors compared to healthy check-up women. J Gynecol Oncol, 22, 103-9. crossref(new window)

18.
World Health Organization (2014). Cost effectiveness and strategic planning (WHO-CHOICE).

19.
Office of the National Economic and Social Development Board (2011. [in Thai]) Bangkok, National Incom of Thailand, Chain Volum Measures: 1990-2010 Edition

20.
Suprasert P, Cheewakriangkrai C, Manopunya M (2012). Outcome of single agent generic gemcitabine in platinumresistant ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma. Asian Pac J Cancer Prev, 13, 517-20. crossref(new window)