Intraperitoneal cisplatin and paclitaxel versus intravenous carboplatin and paclitaxel chemotherapy for Stage III ovarian cancer: A cost-effectiveness analysis
Intraperitoneal cisplatin and paclitaxel versus intravenous carboplatin and paclitaxel chemotherapy for Stage III ovarian cancer: A cost-effectiveness analysis
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DOI：
10.1016/j.ygyno.2007.05.043
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发表时间：
2007-09-01
影响因子：
4.7
通讯作者：
Frick, Kevin D.
中科院分区：
文献类型：
--
作者：
Bristow, Robert E.;Santillan, Antonio;Frick, Kevin D.
目标。评估顺铂腹腔内联合紫杉醇化疗作为III期上皮性卵巢癌患者首选原发细胞减缩手术后一线治疗的成本-效果。基于妇科肿瘤组方案#172和#158，建立决策分析模型，比较最佳残留疾病III期卵巢癌患者的两种治疗策略：(1)住院紫杉醇静脉注射（24小时）和腹腔内顺铂加门诊腹腔内紫杉醇化疗（IP/TV），(2)门诊紫杉醇静脉注射（3小时）和卡铂化疗（IV/M）。从社会的角度对每个策略的成本效益进行了评估。成本-效果分析显示，IP/IV化疗策略的每位患者总成本为39,861美元，有效性为5.16个QALYs，而IV/IV化疗为18,822美元，有效性为4.59个QALYs。IP/IV化疗策略与额外的0.56个qaly相关，增量成本为21,039美元。IP/IV化疗的增量C/E比为37,454美元/QALY。住院费用占IP/IV化疗费用的43.2%。敏感性分析检验证实了模型的稳健性。在这个模型中，IP/IV化疗与质量调整生存时间的适度延长有关，但也比IV/IV化疗更昂贵。总的来说，IP/IV战略可被视为具有良好的医疗保健价值。然而，这些数据也表明，努力降低IP/IV化疗的成本，例如通过开发具有相同治疗效果但改善毒性的门诊方案，将提高这种辅助治疗方案的整体价值。2007爱思唯尔公司版权所有。
Objective. To evaluate the cost-effectiveness of intraperitoneal cisplatin and paclitaxel chemotherapy as front-line treatment for patients with Stage III epithelia] ovarian cancer following optimal primary cytoreductive surgery.Methods. Based on Gynecologic Oncology Group protocols #172 and #158, a decision analysis model was created to compare two treatment strategies for patients with optimal residual disease Stage III ovarian cancer: (1) inpatient intravenous paclitaxel (24 h) and intraperitoneal cisplatin plus outpatient intraperitoneal paclitaxel chemotherapy (IP/TV), and (2) outpatient intravenous paclitaxel (3 h) and carboplatin chemotherapy (IV/M. The cost-effectiveness of each strategy was evaluated from the perspective of society.Results. Cost-effectiveness analysis revealed that the strategy of IP/IV chemotherapy had an overall cost per patient of $39,861 and effectiveness of 5.16 QALYs compared to $18,822 and 4.59 QALYs for IV/IV chemotherapy. The IP/IV chemotherapy strategy was associated with an additional 0.56 QALYs at an incremental cost of $21,039. The incremental C/E ratio for IP/IV chemotherapy was $37,454/QALY. Inpatient treatment accounted for 43.2% of the cost of IP/IV chemotherapy. Sensitivity analysis testing confirmed the robustness of the model.Conclusions. In this model, IP/IV chemotherapy was associated with a modest extension in quality-adjusted survival time but was also more costly than IV/IV chemotherapy. On balance, the IP/IV strategy can be considered a good healthcare value. However, these data also suggest that efforts to reduce the cost of IP/IV chemotherapy, such as through development of an ambulatory regimen with equivalent therapeutic efficacy but an improved toxicity profile, would improve the overall value of this adjuvant treatment program. C 2007 Elsevier Inc. All rights reserved.