Havrilesky Laura J, Secord Angeles Alvarez, Darcy Kathleen M, Armstrong Deborah K, Kulasingam Shalini
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
J Clin Oncol. 2008 Sep 1;26(25):4144-50. doi: 10.1200/JCO.2007.13.1961.
To determine the cost effectiveness of intraperitoneal versus intravenous regimens for adjuvant treatment of optimally resected stage III ovarian cancer.
A decision model was developed to compare the cost effectiveness at 7-, 11.5-, and 35-year horizons of intravenous carboplatin and paclitaxel (IV-CARBO/PAC), intravenous cisplatin and paclitaxel (IV-CIS/PAC), or intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel (IP-CIS/PAC). Survival data were from women participating in representative Gynecologic Oncology Group (GOG) protocols. Medicare reimbursement rates and the Agency for Healthcare Research and Quality Database were used to estimate costs for treatment regimens and grade 3 to 4 adverse effects, respectively.
Median predicted survival was 66, 57, 51, and 48 months for IP-CIS/PAC, IV-CARBO/PAC, IV-CIS/PAC (GOG 172), or IV-CIS/PAC (GOG 158), respectively. Across a range of analyses, IV-CIS/PAC was more costly and had lower life expectancy than IV-CARBO/PAC. Compared with IV-CARBO/PAC, IP-CIS/PAC had an incremental cost-effectiveness ratio (ICER) of $180,022 per quality-adjusted life year (QALY) saved at a 7-year time horizon, $71,835/QALY at 11.5 years, and $32,053/QALY over a lifetime. Extending the survival advantage of IP-CIS/PAC over 11.5 years and a lifetime results in ICERs of $26,249 and $23,973, respectively. Assuming IP-CIS/PAC and IV-CIS/PAC were equally effective when administered on an outpatient basis, the ICER of IP-CIS/PAC compared with IV-CARBO/PAC was $26,311.
Inpatient IP-CIS/PAC, while not cost effective compared with IV-CARBO/PAC at 7 years, becomes cost effective if a longer time horizon is modeled and/or a survival benefit can be assumed to persist longer than currently available data. Outpatient IP-CIS/PAC may also be cost effective compared with IV-CARBO/PAC if proven as effective as inpatient IP-CIS/PAC.
确定腹腔内给药方案与静脉给药方案用于最佳切除的Ⅲ期卵巢癌辅助治疗的成本效益。
建立了一个决策模型，以比较静脉注射卡铂和紫杉醇（IV-CARBO/PAC）、静脉注射顺铂和紫杉醇（IV-CIS/PAC）或静脉注射紫杉醇后腹腔注射顺铂和紫杉醇（IP-CIS/PAC）在7年、11.5年和35年时间跨度下的成本效益。生存数据来自参与代表性妇科肿瘤学组（GOG）方案的女性。医疗保险报销率和医疗保健研究与质量机构数据库分别用于估计治疗方案和3至4级不良反应的成本。
IP-CIS/PAC、IV-CARBO/PAC、IV-CIS/PAC（GOG 172）或IV-CIS/PAC（GOG 158）的中位预测生存期分别为66个月、57个月、51个月和48个月。在一系列分析中，IV-CIS/PAC比IV-CARBO/PAC成本更高且预期寿命更低。与IV-CARBO/PAC相比，IP-CIS/PAC在7年时间跨度下每挽救一个质量调整生命年（QALY）的增量成本效益比（ICER）为180,022美元，在11.5年时为71,835美元/QALY，终身为32,053美元/QALY。将IP-CIS/PAC的生存优势延长至11.5年和终身，ICER分别为26,249美元和23,973美元。假设IP-CIS/PAC和IV-CIS/PAC在门诊给药时效果相同，IP-CIS/PAC与IV-CARBO/PAC相比的ICER为26,311美元。
住院IP-CIS/PAC在7年时与IV-CARBO/PAC相比不具有成本效益，但如果建模时间跨度更长和/或假设生存获益能持续超过现有数据的时间，则具有成本效益。如果门诊IP-CIS/PAC被证明与住院IP-CIS/PAC效果相同，与IV-CARBO/PAC相比也可能具有成本效益。
