Cost effectiveness of concurrent gemcitabine and cisplatin with radiation followed by adjuvant gemcitabine and cisplatin in patients with stages IIB to IVA carcinoma of the cervix

• Published in: Gynecologic oncology 2012-11, Vol.127 (2), p.267-272
• Main Authors: Phippen, Neil T, Leath, Charles A, Chino, Junzo P, Jewell, Elizabeth L, Havrilesky, Laura J, Barnett, Jason C
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cervix cancer; Chemoradiotherapy - economics; Chemotherapy, Adjuvant - economics; Cisplatin - administration & dosage; Cisplatin - economics; Cisplatin - therapeutic use; Cost effectiveness; Cost-Benefit Analysis; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Deoxycytidine - economics; Deoxycytidine - therapeutic use; Female; Gemcitabine; Hematology, Oncology and Palliative Medicine; Humans; Markov Chains; Middle Aged; Models, Statistical; Neoplasm Staging; Obstetrics and Gynecology; Quality of Life; Quality-Adjusted Life Years; Survival Analysis; Treatment Outcome; United States; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.08.002

Abstract Objective A recent phase III trial reported gemcitabine with cisplatin chemoradiation followed by 2 cycles of gemcitabine and cisplatin (G) significantly improved progression-free (PFS) and overall survival (OS) compared to standard cisplatin chemoradiation (C) for locally advanced cervix cancer. We evaluate the cost effectiveness (CE) of these treatment regimens. Methods A modified Markov model was constructed comparing CE between treatment arms using the published trial's five-year OS and treatment-related toxicity rates. Quality of life (QOL) utility scores during treatment were obtained from published literature and modeled for sensitivity analysis. Cost data was obtained from Medicare reimbursement figures and the Healthcare Cost and Utilization Project. One-way sensitivity analyses assessed variations in cost and adverse events. Results Mean cost was $41,330 (US$) for C versus $60,974 for G. Incremental cost-effectiveness ratio (ICER) for G compared to C was $33,080 per quality-adjusted life year (QALY). In sensitivity analyses (SA), the ICER increased to common willingness-to-pay thresholds of 50 K and 100 K when QOL utility scores during G active treatment declined to 0.64 and 0.53 (baseline 0.76), respectively. The model was insensitive to changes in adverse event rates, costs of treatment, or adverse event hospitalization costs. Conclusions Gemcitabine with cisplatin chemoradiation followed by 2 cycles of adjuvant gemcitabine and cisplatin is a cost effective treatment for locally advanced cervix cancer compared to standard cisplatin chemoradiation. Common willingness to pay thresholds are exceeded during sensitivity analyses with realistic declines in QOL. Our results support ongoing investigations of novel adjuvants to standard cisplatin chemoradiation with potentially less toxicity.