Intraperitoneal Chemo for Stage III Ovarian Cancer Not Cost-Effective in Short Term

NEW YORK (Reuters Health) Oct 28 - A new strategy that improves survival in stage III ovarian cancer patients is not cost-effective in the short term but would be cost-effective in the long term if the survival advantage persists, according to a paper in the September issue of the Journal of Clinical Oncology.

The new approach, employed in women with optimally resected ovarian cancer, uses a combination of intraperitoneal and intravenous chemotherapy. Dr. Laura J. Havrilesky of Duke University Medical Center in Durham, North Carolina, and colleagues explain that in a previous trial in women with stage III ovarian cancer, intraperitoneal cisplatin and paclitaxel plus intravenous paclitaxel yielded a survival advantage of more than a year compared with intravenous cisplatin and paclitaxel alone.

However, Dr. Havrilesky told Reuters Health, “One caveat of that randomized trial was a higher rate of severe complications in the intraperitoneal group.” These complications prompted the cost-benefit analysis.

“We wanted to explore whether the costs of the added toxicity outweighed the potential survival advantage,” she said. “Our decision model incorporated the time and costs of both types of treatment as well as the costs of treating complications and the relative reduction in quality of life that occurs during administration of each type of chemotherapy.”

Using data from women enrolled in Gynecologic Oncology Group protocols, the researchers constructed a model that compared the costs of three currently available regimens for ovarian cancer at 7-, 11.5- and 35-year horizons: intravenous carboplatin and paclitaxel, intravenous cisplatin and paclitaxel, and intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel.

“We found that over a short term follow up of 7 years — the length of actual follow-up now available for GOG 172 — intraperitoneal chemotherapy did not appear to be cost-effective,” Dr. Havrilesky said. “But if we look forward and assume the survival advantage already observed on this study continues to persist over a longer period of time, the benefits in survival outweigh the costs of extra toxicity and of additional treatment expense, so that intraperitoneal chemotherapy is potentially cost-effective over a lifetime.”

The investigators point out that the “relatively high” incremental cost-effectiveness ratio of $180,022 for the intraperitoneal regimen compared with intravenous carboplatin/paclitaxel at 7 years appears to be driven by the higher costs of inpatient chemotherapy.

However, the paper concludes: “If intraperitoneal chemotherapy can be conducted on an outpatient basis with a comparable and lasting survival advantage, this regimen has an attractive incremental cost-effectiveness ratio compared with IV carboplatin and paclitaxel.”

Source:

1. Intraperitoneal Chemo for Stage III Ovarian Cancer Not Cost-Effective in Short Term