ECONOMIC AND POLICY IMPLICATIONS OF ADOPTING PACLITAXEL AS FIRST-LINETHERAPY FOR ADVANCED OVARIAN-CANCER - AN ONTARIO PERSPECTIVE

Purpose: To determine the potential economic and policy implications t hat result from incorporating paclitaxel into first-line therapy for s tage 3 and 4 ovarian cancer patients in the province of Ontario, Canad a. Methods: A cost-effectiveness analysis was conducted to compare cis platin/cyclophosphamide (CC), ct standard therapy, with cisplatin/pacl itaxel (CT). Based on survival curves from a clinical trial, mean cost s and survival were calculated. Sensitivity analyses were conducted ba sed on altering the duration of paclitaxel infusion, discount rates, a nd efficacy of paclitaxel. Results: The mean survival duration is prol onged from 2.06 years with the standard therapy to 2.44 years with the paclitaxel combination. The paclitaxel therapy is more expensive, wit h a mean cost of $17,469 (Canadian) per patient treated with CT compar ed 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 fo r advanced ovarian cancer patients in Ontario requires on additional $ 9 million per year over and above the present costs to treat this pati ent population. Conclusion: Although paclitaxel-based therapy prolongs survival, it comes at an increased cost. It may not be possible to fo nd paclitaxel treatment using resources presently allocated to first-l ine chemotherapy for advanced ovarian cancer. The policy implications for absorbing the cost of paclitaxel in the context of a publicly fund ed health care system are discussed. (C) 1997 by American Society of C linical Oncology.