Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer

• Published in: Gynecologic oncology 2012-06, Vol.125 (3), p.631-634
• Main Authors: Havrilesky, Laura J, Garfield, Craig F, Barnett, Jason C, Cohn, David E
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents, Phytogenic - economics; Antineoplastic Agents, Phytogenic - supply & distribution; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Carboplatin - economics; Drug Costs - statistics & numerical data; Drug shortage; Female; Hematology, Oncology and Palliative Medicine; Humans; Markov Chains; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - economics; Paclitaxel; Paclitaxel - administration & dosage; Paclitaxel - economics; Paclitaxel - supply & distribution; Quality of Life; Taxoids - administration & dosage; Taxoids - adverse effects; United States
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.03.028

Abstract Objective To determine the potential economic impact of a paclitaxel drug shortage in patients with newly diagnosed, untreated ovarian cancer. Methods A modified Markov state transition model with a 6 cycle time horizon compared two scenarios: (1) Standard treatment (STD): paclitaxel 175 mg/m2/carboplatin AUC 5 × 6 cycles; (2) Paclitaxel drug shortage (DS): docetaxel 75 mg/m2/carboplatin AUC 5 × 6 cycles. Adverse events, quality of life, and costs of chemotherapy, neuropathy, febrile neutropenia, and anemia were incorporated. Key assumptions: (1) Costs and consequences were assigned only to grade 2 + neuropathy, febrile neutropenia, and grade 3–4 anemia; (2) Grade 2 + neuropathy prompted a switch from paclitaxel/carboplatin to docetaxel/carboplatin or from docetaxel/carboplatin to carboplatin alone; (3) Febrile neutropenia resulted in inpatient hospitalization followed by G-CSF prophylaxis. Results The mean cost of 6 cycles of chemotherapy was $4939 in the STD and $16,107 in the DS scenario, for a cost difference of $11,168 per patient over 6 cycles of treatment. STD was the dominant strategy (less expensive and more effective than the drug shortage scenario). In sensitivity analysis, DS was more costly over a wide range of clinical estimates in each arm. A drug shortage that affects approximately 50% of women initiating chemotherapy is expected to impact 779 women and cost third party payers an additional $8,699,872 monthly. Conclusions Our model indicates that chemotherapy drug shortages can have a significant negative impact on the average cost of primary treatment for ovarian cancer and have the potential to negatively impact health system costs.