Markov-modeling for the administration of platinum analogues and paclitaxel as first-line chemotherapy as well as topotecan and liposomal doxorubicin as second-line chemotherapy with epithelial ovarian carcinoma.

PURPOSE: So far there is no analysis available on the cost effectiveness of the paclitaxel/platinum-analogue combination versus carboplatin monotherapy with ovarian cancer. Up-to-now only a cost-utility analysis on ovarian carcinoma has been published (Ortega et al. in Gynecol Oncol 66(3):454-463, 1997), which in addition to the first-line chemotherapy included second-line chemotherapy with effectiveness and cost data in the analysis. Therefore, within the scope of our study the cost effectiveness of platinum analogues and paclitaxel as first-line chemotherapy as well as topotecan and liposomal doxorubicin as second-lie chemotherapy was to be determined with epithelial ovarian carcinoma.
METHODS: For this purpose a decision-making Markov model was developed which represents the medical and economic consequences of the administration of paclitaxel and platinum derivatives in first-line chemotherapy and the administration of topotecan and liposomal doxorubicin in second-line chemotherapy in the treatment of epithelial ovarian carcinoma by means of data from the literature. Patients were treated either in the early (FIGO stage I-IIa) or advanced stage (FIGO stage IIb-IV).
RESULTS: The therapeutic strategy caboplatin followed by topotecan costs 20,123.91 euros, the therapeutic strategy carboplatin followed by liposomal doxorubicin 22,336.57 euros, the therapeutic strategy carboplatin/pactlitaxel followed by liposomal topotecan 29,820.64 euros and the therapeutic strategy carboplatin/paclitaxel followed by liposomal doxorubicin 31,560.47 euros from the time of diagnosis until death or survival within 5 years. With lives saved, accordingly of 2.55, 2.70, 2.60 and 2.65 years' costs amounted to 7,891 euros, 8,270.35 euros, and 11,453.62 euros per year of life saved.
CONCLUSIONS: Based on the threshold value of social willingness to pay 45,500 euros per year of life saved, the therapeutic strategy carboplatin followed by topotecan, the therapeutic strategy carboplatin followed by liposomal doxorubicin, the therapeutic strategy carboplatin/paclitaxel followed by topotcan and the therapeutic strategy carboplatin/paclitaxel followed by liposomal doxorubicin can be evaluated to be cost effective.