COST-EFFECTIVENESS ANALYSIS COMPARING LIPOSOMAL ANTHRACYCLINES IN THETREATMENT OF AIDS-RELATED KAPOSIS-SARCOMA

Liposomal formulations have been shown to alter the efficacy and toxic ity profiles of anthracylines for patients with HIV-related advanced K aposi's sarcoma (KS). Using decision-analysis models, the costs and co st-effectiveness of the two U.S. Food and Drug Administration (FDA)-ap proved liposomal formulations of these agents were estimated. Estimate s of costs, effectiveness, and cost-effectiveness were derived from cl inical trial data of separate, randomized phase III trials of pegylate d liposomal doxorubicin (20 mg/m(2) every 3 weeks) and liposomal dauno rubicin (40 mg/m(2) every 2 weeks). Clinical response rates were 59% f or pegylated liposomal doxorubicin and 25% for liposomal daunorubicin. Despite higher acquisition costs fur pegylated liposomal doxorubicin, total estimated costs of treatment for KS and chemotherapy-related he matologic toxicities were similar ($7,066 U.S. compared with $6,621 U. S, for Liposomal daunorubicin). Cost-effectiveness profiles, defined a s average costs per responder, favored pegylated liposomal doxorubicin ($11,976 U.S./responder versus $26,483 U.S./responder for Liposomal d aunorubicin), reflecting the higher reported response rate in the phas e III trial. Sensitivity analyses suggested that the costs and cost-ef fectiveness results would not differ markedly when evaluated over a ra nge of assumptions, including response rate, neutropenia rate, and dos age variations.