Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer
Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer
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DOI：
10.1002/cncr.26199
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发表时间：
2012-01-15
期刊：
影响因子：
6.2
通讯作者：
Secord, Angeles Alvarez
中科院分区：
文献类型：
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作者：
Havrilesky, Laura J.;Pokrzywinski, Robin;Secord, Angeles Alvarez
背景技术背景：在一项针对复发性铂类敏感性卵巢癌患者的随机对照试验（RCT）中，每周一次多西他赛联合卡铂治疗的无进展生存期（PFS）为13.7个月，而序贯多西他赛单药治疗后卡铂为8.4个月。本研究的目的是构建一个成本效用模型，以比较这2种方案，并纳入前瞻性收集的生活质量（QoL）数据。方法：一项多西他赛联合卡铂（cDC）与多西他赛联合卡铂（序贯多西他赛联合卡铂[ sDC]）的RCT是Markov决策模型的基础，主要有效性结局为PFS。根据医疗保险对化疗方案、骨髓支持和不良事件管理的报销，使用美元估计费用。使用癌症治疗功能评估-一般问卷获得的QoL数据转换为效用。成本和增量成本效益比（ICER）以每质量调整生命年（QALY）的美元报告。进行了广泛的单因素敏感性分析和Monte Carlo概率敏感性分析。结果：最便宜的策略是sDC，平均花费20,381美元，而cDC平均花费25122美元。与sDC相比，cDC的ICER为25，239美元/QALY。cDC仍然具有成本效益，ICER
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