COST-UTILITY ASSESSMENT OF AMIFOSTINE AS FIRST-LINE THERAPY FOR OVARIAN-CANCER

Nearly 27,000 female patients were diagnosed with ovarian cancer in th e United States in 1997. While chemotherapeutic agents are effective i n prolonging the time to progression of disease, concerns exist over t reatment-related toxicities. In addition to considerations related to effectiveness, the decision to prescribe new cytoprotective agents req uires consideration of costs and cost-effectiveness. The objective of this study was to describe cost-utility estimates of a new supportive care agent, amifostine, and to illustrate these issues for patients wi th ovarian cancer. The phase III Food and Drug Administration (FDA) li censing trial found that pretreatment with amifostine prior to each cy cle of chemotherapy resulted in reduction of cumulative toxicities wit h cyclophosphamide and cisplatinum. While amifostine use is approximat ely $3,146 more per patient, after adjustment for direct medical costs and potential health status changes from reductions in hematologic to xicity, neurotoxicity, and nephrotoxicity, its use was estimated to co st $36,161 in direct medical costs per quality-adjusted life year save d. Sensitivity analyses indicated that cost-effectiveness estimates of amifostine therapy ranged from $25,474 to $78,574. Based on the phase III FDA licensing trial, amifostine use is associated with a favorabl e cost-utility profile that is in the range associated with widely use d cancer therapeutic and supportive care agents. The decision to use ( or not use) amifostine in conjunction with cisplatin and cyclophospham ide for women with ovarian cancer should be based on clinical, not eco nomic, considerations.