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Role of chemotherapy for patients with recurrent platinum-resistant advanced epithelial ovarian cancer†
A cost-effectiveness analysis
Article first published online: 27 JUN 2006
Copyright © 2006 American Cancer Society
Volume 107, Issue 3, pages 536–543, 1 August 2006
How to Cite
Rocconi, R. P., Case, A. S., Straughn, J. M., Estes, J. M. and Partridge, E. E. (2006), Role of chemotherapy for patients with recurrent platinum-resistant advanced epithelial ovarian cancer. Cancer, 107: 536–543. doi: 10.1002/cncr.22045
Presentation in oral format at the 36th Annual Meeting of the Society of Gynecologic Oncologists, March 18–23, 2005, Miami, Florida.
- Issue published online: 18 JUL 2006
- Article first published online: 27 JUN 2006
- Manuscript Accepted: 5 APR 2006
- Manuscript Revised: 30 MAR 2006
- Manuscript Received: 31 OCT 2005
- ovarian cancer;
- cost-effectiveness analysis;
- best supportive care
Current chemotherapy in platinum-resistant ovarian cancer patients has demonstrated minimal to no improvements in survival. Despite the lack of benefit, significant resources are utilized with such therapies. Therefore, the objective in the current study was to assess the cost-effectiveness of salvage chemotherapy for patients with platinum-resistant epithelial ovarian cancer (EOC).
A decision analysis model evaluated a hypothetical cohort of 4000 platinum-resistant patients with recurrent EOC. Several chemotherapy strategies were analyzed: 1) best supportive care (BSC); 2) second-line chemotherapy-monotherapy; 3) second-line chemotherapy-combination therapy; 4) third-line chemotherapy after disease progression on second-line monotherapy; and 5) third-line chemotherapy after disease progression on second-line combination therapy. Sensitivity analyses were performed on all pertinent uncertainties.
Using costs alone, BSC was the only definitive cost-effective treatment for platinum-resistant recurrent ovarian cancer patients, and second-line monotherapy was a reasonable cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of $64,104. The cost-effectiveness ranged from $4,065 per month of overall survival (OS) for BSC to $12,927 for third-line previous combination therapy. Compared with BSC, second-line monotherapy gained an additional 3 months of OS, with a cost-effectiveness of $4,703 per month of OS. Second-line combination therapy and third-line therapies exhibited unfavorable ICER.
The current decision analysis was intended to be thought-provoking and bring awareness to the high costs of subsequent chemotherapy with limited effectiveness in patients with recurrent platinum-resistant EOC. Although actual patients may receive multiple lines of chemotherapy, from the perspective of costs alone this model using a hypothetical cohort demonstrated that best supportive care was the only cost-effective strategy, with second-line monotherapy appearing to be a reasonable cost-effective strategy given current chemotherapeutic options. Cancer 2006. © 2006 American Cancer Society.