TREATMENTS FOR NEWLY-DIAGNOSED ADVANCED OVARIAN-CANCER - ANALYSIS OF SURVIVAL-DATA AND COST-EFFECTIVENESS EVALUATION

The main therapeutic options currently available for patients with new ly diagnosed advanced ovarian cancer include: (i) cisplatin-based chem otherapy at conventional doses without paclitaxel, (ii) paclitaxel+cis platin at conventional doses and (iii) high-dose chemotherapy with aut ologous hematopoietic rescue. After conducting a literature search to identify large-scale clinical trials based on these three therapeutic modalities, we carried out an analysis of the survival data and evalua ted the cost-effectiveness ratio where appropriate. Cost data were obt ained from published information. Effectiveness was estimated by deter mining the values of mean lifetime survival (MLS). Our analysis includ ed a total of 15 clinical trials. The values of MLS were 3.05 years pe r patient for cisplatin-based chemotherapy at conventional doses witho ut paclitaxel (1931 patients), 2.95 years per patient for chemotherapy with paclitaxel+cisplatin at conventional doses (184 patients) and 5. 76 years per patient for high-dose chemotherapy with autologous hemato poietic rescue (53 patients). As compared with cisplatin-based chemoth erapy without paclitaxel, high-dose treatments with hematopoietic resc ue yielded a significantly better survival. Using cisplatin-based chem otherapy as a reference term, the incremental cost-effectiveness ratio for high-dose treatments was $25 641 per life year gained (discounted dollars per discounted life year gained). Sensitivity testing suggest ed that the ratio remained below $50 000 under most circumstances. We conclude that in the treatment of patients with advanced ovarian cance r, high-dose chemotherapy with hematopoietic rescue seems to be more e ffective and more cost-effective than standard treatments with cisplat in-based regimens at conventional doses. [(C) 1998 Lippincott-Raven Pu blishers.].