Covens A, Boucher S, Roche K, Macdonald M, Pettitt D, Jolain B, Souetre E, Rivière M
Toronto-Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada.
Cancer. 1996 May 15;77(10):2086-91. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2086::AID-CNCR18>3.0.CO;2-R.
Paclitaxel and cisplatin use for the treatment of advanced ovarian carcinoma (AOC) has been shown to increase median survival duration. An evaluation was performed on the economic consequences of treating AOC patients with combined paclitaxel and cisplatin chemotherapy compared with current usual care, i.e., combined cyclophosphamide and cisplatin chemotherapy.
Linear modeling techniques combined with retrospective chart analysis were used to predict the clinical progression and treatment of AOC patients until death. Cost-effectiveness analysis comparing paclitaxel and cisplatin and usual care was performed from a simplified Ministry of Health perspective.
Assuming a 50% increase in survival for paclitaxel and cisplatin patients, an assumption supported by recent clinical trial data, this treatment showed an average lifetime cost per patient of $50,054 Cdn compared with a cost of $36,837 Cdn for usual care. The incremental cost of the paclitaxel and cisplatin treatment over the usual treatment was $20,355 Cdn per life year gained. These results withstood extensive sensitivity analyses.
Paclitaxel, in combination with cisplatin, appears to be a cost-effective first-line treatment for AOC. A moderate increase in incremental cost compares favorably with other life-saving strategies currently in use. As more data become available for the use of paclitaxel, this pilot study will provide a basis for more extensive economic evaluation of paclitaxel.
已证明使用紫杉醇和顺铂治疗晚期卵巢癌（AOC）可延长中位生存期。对采用紫杉醇与顺铂联合化疗治疗AOC患者与当前常规治疗（即环磷酰胺与顺铂联合化疗）的经济后果进行了评估。
采用线性建模技术结合回顾性病历分析来预测AOC患者直至死亡的临床进展和治疗情况。从简化的卫生部视角对紫杉醇和顺铂联合治疗与常规治疗进行了成本效益分析。
假设紫杉醇和顺铂治疗的患者生存期增加50%，这一假设得到近期临床试验数据的支持，该治疗显示每位患者的平均终生成本为50,054加元，而常规治疗的成本为36,837加元。与常规治疗相比，紫杉醇和顺铂治疗每获得一个生命年的增量成本为20,355加元。这些结果经广泛的敏感性分析后依然成立。
紫杉醇与顺铂联合似乎是一种治疗AOC的具有成本效益的一线治疗方法。与目前使用的其他挽救生命的策略相比，增量成本适度增加是有利的。随着更多关于紫杉醇使用的数据可用，这项初步研究将为更广泛的紫杉醇经济评估提供基础。
