Journal of Clinical Oncology, Vol 15, 632-639, Copyright © 1997 by American Society of Clinical Oncology
Economic and policy implications of adopting paclitaxel as first-line therapy for advanced ovarian cancer: an Ontario perspective
LM Elit, A Gafni and MN Levine
Department of Obstetrics and Gynaecology, University of Western Ontario, London, Canada. lelit@lhsc.on.ca
PURPOSE: To determine the potential economic and policy implications that
result from incorporating paclitaxel into first-line therapy for stage 3
and 4 ovarian cancer patients in the province of Ontario, Canada. METHODS:
A cost-effectiveness analysis was conducted to compare
cisplatin/cyclophosphamide (CC), a standard therapy, with
cisplatin/paclitaxel (CT). Based on survival curves from a clinical trial,
mean costs and survival were calculated. Sensitivity analyses were
conducted based on altering the duration of paclitaxel infusion, discount
rates, and efficacy of paclitaxel. RESULTS: The mean survival duration is
prolonged from 2.06 years with the standard therapy to 2.44 years with the
paclitaxel combination. The paclitaxel therapy is more expensive, with a
mean cost of $17,469 (Canadian) per patient treated with CT compared with
$5,228 per patient with CC. The incremental cost- effectiveness ratio is
$32,213 per year gained. Sensitivity analyses show that the conclusions
remain unchanged. The use of CT as first-line treatment for advanced
ovarian cancer patients in Ontario requires an additional $9 million per
year over and above the present costs to treat this patient population.
CONCLUSION: Although paclitaxel-based therapy prolongs survival, it comes
at an increased cost. It may not be possible to fund paclitaxel treatment
using resources presently allocated to first-line chemotherapy for advanced
ovarian cancer. The policy implications for absorbing the cost of
paclitaxel in the context of a publicly funded health care system are
discussed.
