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Cost effectiveness of concurrent gemcitabine and cisplatin with radiation followed by adjuvant gemcitabine and cisplatin in patients with stages IIB to IVA carcinoma of the cervix.
- Source :
-
Gynecologic oncology [Gynecol Oncol] 2012 Nov; Vol. 127 (2), pp. 267-72. Date of Electronic Publication: 2012 Aug 11. - Publication Year :
- 2012
-
Abstract
- Objective: A recent phase III trial reported gemcitabine with cisplatin chemoradiation followed by 2 cycles of gemcitabine and cisplatin (G) significantly improved progression-free (PFS) and overall survival (OS) compared to standard cisplatin chemoradiation (C) for locally advanced cervix cancer. We evaluate the cost effectiveness (CE) of these treatment regimens.<br />Methods: A modified Markov model was constructed comparing CE between treatment arms using the published trial's five-year OS and treatment-related toxicity rates. Quality of life (QOL) utility scores during treatment were obtained from published literature and modeled for sensitivity analysis. Cost data was obtained from Medicare reimbursement figures and the Healthcare Cost and Utilization Project. One-way sensitivity analyses assessed variations in cost and adverse events.<br />Results: Mean cost was $41,330 (US$) for C versus $60,974 for G. Incremental cost-effectiveness ratio (ICER) for G compared to C was $33,080 per quality-adjusted life year (QALY). In sensitivity analyses (SA), the ICER increased to common willingness-to-pay thresholds of 50 K and 100 K when QOL utility scores during G active treatment declined to 0.64 and 0.53 (baseline 0.76), respectively. The model was insensitive to changes in adverse event rates, costs of treatment, or adverse event hospitalization costs.<br />Conclusions: Gemcitabine with cisplatin chemoradiation followed by 2 cycles of adjuvant gemcitabine and cisplatin is a cost effective treatment for locally advanced cervix cancer compared to standard cisplatin chemoradiation. Common willingness to pay thresholds are exceeded during sensitivity analyses with realistic declines in QOL. Our results support ongoing investigations of novel adjuvants to standard cisplatin chemoradiation with potentially less toxicity.<br /> (Published by Elsevier Inc.)
- Subjects :
- Antineoplastic Agents administration & dosage
Antineoplastic Agents economics
Antineoplastic Combined Chemotherapy Protocols economics
Chemotherapy, Adjuvant economics
Cisplatin administration & dosage
Cisplatin economics
Cost-Benefit Analysis
Deoxycytidine administration & dosage
Deoxycytidine economics
Deoxycytidine therapeutic use
Female
Humans
Markov Chains
Middle Aged
Models, Statistical
Neoplasm Staging
Quality of Life
Quality-Adjusted Life Years
Survival Analysis
Treatment Outcome
United States
Uterine Cervical Neoplasms economics
Uterine Cervical Neoplasms mortality
Uterine Cervical Neoplasms pathology
Gemcitabine
Antineoplastic Agents therapeutic use
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Chemoradiotherapy economics
Cisplatin therapeutic use
Deoxycytidine analogs & derivatives
Uterine Cervical Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1095-6859
- Volume :
- 127
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Gynecologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 22892361
- Full Text :
- https://doi.org/10.1016/j.ygyno.2012.08.002