Rocconi Rodney P, Case Ashley S, Straughn J Michael, Estes Jacob M, Partridge Edward E
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
Cancer. 2006 Aug 1;107(3):536-43. doi: 10.1002/cncr.22045.
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).
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.
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 dollars. The cost-effectiveness ranged from 4,065 dollars per month of overall survival (OS) for BSC to 12,927 dollars 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 dollars per month of OS. Second-line combination therapy and third-line therapies exhibited unfavorable ICER.
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.
目前针对铂耐药卵巢癌患者的化疗在生存改善方面显示出极小的效果甚至没有改善。尽管缺乏益处，但此类治疗仍消耗了大量资源。因此，本研究的目的是评估挽救性化疗对铂耐药上皮性卵巢癌（EOC）患者的成本效益。
一个决策分析模型评估了4000名铂耐药复发性EOC患者的假设队列。分析了几种化疗策略：1）最佳支持治疗（BSC）；2）二线化疗 - 单药治疗；3）二线化疗 - 联合治疗；4）二线单药治疗疾病进展后的三线化疗；5）二线联合治疗疾病进展后的三线化疗。对所有相关不确定性进行了敏感性分析。
仅从成本来看，BSC是铂耐药复发性卵巢癌患者唯一明确具有成本效益的治疗方法，二线单药治疗是一种合理的成本效益策略，增量成本效益比（ICER）为64,104美元。成本效益范围从BSC的每总生存期（OS）每月4,065美元到之前二线联合治疗的三线治疗的12,927美元。与BSC相比，二线单药治疗使OS额外增加了3个月，成本效益为每OS每月4,703美元。二线联合治疗和三线治疗表现出不利的ICER。
当前的决策分析旨在引发思考，并使人们意识到复发性铂耐药EOC患者后续化疗成本高昂且效果有限。尽管实际患者可能接受多线化疗，但仅从成本角度来看，使用假设队列的该模型表明最佳支持治疗是唯一具有成本效益的策略，鉴于当前的化疗选择，二线单药治疗似乎是一种合理的成本效益策略。
