BACKGROUND: Most economic evaluations for chemotherapies in ovarian cancer patients have been carried out using hypothetical cohorts but evidence integrating real world survival, cost, and utility data is limited.
OBJECTIVES: To compare the costs and quality adjusted life years (QALYs) gained from various chemotherapy regimens among ovarian cancer patients using a costutility analysis.
METHODS: A propensity score matched cohort of 6,856 (65 years and older) ovarian cancer patients, from the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data, diagnosed from 1991 to 2005 were included. Chemotherapy treatments (i.e. no chemotherapy; platinum-based only; platinum plus taxane and other non-platinum based regimens) were identified in the first 6 months after diagnosis. Patients were followed until death or the end of study period (December 2006). Effectiveness was measured in QALYs by adjusting the overall survival benefit with phase and disease specific utilities obtained from the literature. Total direct health care costs were measured using a payer's perspective and were adjusted for inflation as well as geographic differences in costs. Costs are presented as 2009 US $ with 3% annual discounting applied to both costs and QALYs. Methodological and statistical uncertainties were accounted for by including alternate scenarios (for utility values) and a net monetary benefit approach, respectively. Incremental cost effectiveness ratios (ICERs) were calculated and stratified by various tumor stages and age groups.
RESULTS: Compared to the no chemotherapy group, ICER in the platinum-based only group was $60,084/ QALY in the base case, while other non-platinum and platinum plus taxane groups were dominated. Similar results were found across various tumor stages and age groups. However, for patients 85 years and older platinum plus taxane group was not dominated by the platinum-based only group, with an ICER of $133,892/QALY.
CONCLUSIONS: Following ovarian cancer patients using real world longitudinal claims data and adjusting for quality of life, we found that treatment with platinum based only regimen was the most cost-effective treatment.
