Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer

Authors

  • Laura J. Havrilesky MD, MHSc,

    Corresponding author
    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
    2. Duke Cancer Institute, Durham, North Carolina
    • Box 3079 DUMC, Durham, NC 27710

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    • Fax: (919) 684-8719

  • Robin Pokrzywinski MHA,

    1. United Biosource, Bethesda, Maryland
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  • Dennis Revicki PhD,

    1. United Biosource, Bethesda, Maryland
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  • Robert V. Higgins MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina
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  • Lawrence R. Nycum MD,

    1. Division of Gynecologic Oncology, Forsyth Regional Cancer Center, Winston-Salem, North Carolina
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  • Matthew F. Kohler MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
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  • Andrew Berchuck MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
    2. Duke Cancer Institute, Durham, North Carolina
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  • Evan R. Myers MD, MPH,

    1. Duke Cancer Institute, Durham, North Carolina
    2. Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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  • Angeles Alvarez Secord MD

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
    2. Duke Cancer Institute, Durham, North Carolina
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Abstract

BACKGROUND:

In a randomized controlled trial (RCT) of patients with recurrent, platinum-sensitive ovarian cancer, the combination weekly docetaxel and carboplatin was associated a with progression-free survival (PFS) of 13.7 months compared with 8.4 months for sequential, single-agent docetaxel followed by carboplatin. The objective of the current study was to construct a cost-utility model to compare these 2 regimens with the incorporation of prospectively collected quality-of-life (QoL) data.

METHODS:

An RCT of concurrent docetaxel and carboplatin (cDC) versus docetaxel followed by carboplatin (sequential docetaxel and carboplatin [sDC]) was the basis for a Markov decision model, and the primary effectiveness outcome was PFS. Costs were estimated using US dollars based on Medicare reimbursements for chemotherapy regimens, bone marrow support, and management of adverse events. QoL data obtained using the Functional Assessment of Cancer Therapy-General questionnaire were converted to utilities. Costs and incremental cost-effectiveness ratios (ICERs) were reported in US dollars per quality-adjusted life year (QALY). Extensive 1-way sensitivity analyses and a Monte Carlo probabilistic sensitivity analysis were performed.

RESULTS:

The least expensive strategy was sDC, which cost an average of $20,381, compared with cDC, which cost an average of $25,122. cDC had an ICER of $25,239 per QALY compared with sDC. cDC remained cost-effective, with an ICER <$50,000 per QALY, over a range of costs and estimates. In Monte Carlo sensitivity analysis using a $50,000 per QALY willingness-to-pay threshold, cDC was either dominant or cost-effective with an ICER <$50,000 per QALY in 83% of simulations.

CONCLUSIONS:

Combined weekly cDC appeared to be cost-effective compared with sDC as treatment strategy for patients with platinum-sensitive ovarian cancer, even when accounting for slightly lower QoL during treatment. Cancer 2011;. © 2011 American Cancer Society.

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