Role of chemotherapy for patients with recurrent platinum‐resistant advanced epithelial ovarian cancer

Abstract

BACKGROUND. 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). METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for advanced recurrent or refractory ovarian cancer: a systematic review and economic evaluation

“…These 21 studies were considered by the TAG to be the most relevant to this MTA, and were extracted in full (see Appendix 7); the remaining included papers are presented as short summaries (see Appendix 7). Papaioannou et al 90 Chan et al 96 Ojeda et al 83 Main et al 97 Havrilesky et al 98 Papaioannou et al 99 Lesnock et al 100 Lesnock et al 101 Smith et al Case et al 103 Havrilesky et al 104 Montalar et al 105 Rocconi et al Of the 21 economic evaluations identified in patients with recurrent ovarian cancer, 10,15,16,[82][83][84][85][86]90,[94][95][96][97][98][99][100][101][102][103][104][105][106][107] four studies [82][83][84]95 were published prior to 2004 and describe cost-minimisation analyses comparing PLDH with topotecan. These studies were carried out from the perspective of Italy, 84 Spain, 83 the UK, 82,95 and the USA.…”

“…82 Three of these studies [82][83][84] were identified from the literature search for economic evaluations carried out in TA91, and are reviewed in detail within the TA91 Technology Assessment Report. 13 Three 15,90,99 of the 21 identified studies 10,15,16,[82][83][84][85][86]90,[94][95][96][97][98][99][100][101][102][103][104][105][106][107] were directly related to TA222, 15 of which this MTA is, in part, a review and update (for a description of TA222, 15 see Review of TA91 and TA222 cost-effectiveness evidence, above). A further two studies 102,105 were published subsequent to TA222: 15 Gore et al 102 is a poster describing a cost-utility analysis of trabectedin in combination with PLDH compared with PLDH using more recent estimates of survival.…”

“…Of the remaining nine economic evaluations identified, 16,96,98,100,101,103,104,106,107 one was carried out from the perspective of the UK ( TA285 15 ) and was a STA considering the cost-effectiveness of bevacizumab in recurrent ovarian cancer. The model developed by the manufacturer for this STA was a semi-Markov model based upon the model structure outlined in TA91 13 (i.e.…”

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

“…Rocconi et al previously reported that the only potentially cost-effective management strategies for platinum-resistant recurrence were single-agent treatments and supportive care. 11 Our study is strengthened by the results from a probabilistic sensitivity analysis, which simultaneously accounts for uncertainty in each of the model's parameters. In Monte Carlo analysis using $50,000 per QALY as the ''willingness to pay'' threshold, cDC is the clear treatment of choice in 83% of simulations.…”

Phase 2 study of intraperitoneal topotecan as consolidation chemotherapy in ovarian and primary peritoneal carcinoma

“…15 Intravenous topotecan has demonstrated reasonable clinical activity against both platinum-sensitive and platinum-resistant recurrent ovarian cancer, with overall response rates ranging from 29% to 33% and 7% to 23%, respectively. [16][17][18][19][20] Moreover, i.v. topotecan has been approved by the United Stated Food and Drug Administration for these indications.…”