Cisplatin and paclitaxel may be the most cost-effective chemotherapy combination for women with advanced, persistent, or recurrent cervical cancer, according to research published in Dovepress.
In the study, researchers led by Natalie Klag, Cancer Treatment Centers of America (Newnan, GA), used a cost-effectiveness model to analyze four different chemotherapy regimens: cisplatin/paclitaxel (CP); CP with bevacizumab (CP+B); paclitaxel/topotecan (PT); and PT with bevacizumab (PT+B). All regimens were modeled for seven cycles with survival, cost, and complications evaluated.
Overall, the mean chemotherapy costs over mean total costs for each regimen were: CP $571/$32,966; CP+B $61,671/$96,842; PT $9,211/$71,620; and PT+B $70,312/$109,211. Incremental cost-effectiveness ratios (ICER) for CP+B, PT+B, and PT were $133,559 per quality-adjusted life year, $124,576 per quality-adjusted life year, and $511,947 per quality adjusted life year, respectively. No ICER was recorded for CP due to the steep cost frontier from CP to PT+B and none were found to be below a willingness-to-pay threshold of $50,0000.
Additional analysis revealed that treating 1000 women with CP+B for cervical cancer would cost ~67% more than treating over 18,000 women with first-line chemotherapy (carboplatin and paclitaxel), indicating that the use of any regimen besides CP could create a significant cost burden on the entire health care system.
Researchers concluded that the standard of care for patients with advanced, persistent, or recurrent cervical cancer should not be changed from CP until a regimen with a much more significant survival benefit or lower cost can be found.
“All physicians want better survival for their patients, but it has to be sustainable,” the authors wrote. “Rationing health care is not ethical, but neither is spending money on treatments that are not worth the expense. We need to rationally approach changes in standards of care so that we can treat the most patients with the best possible treatments.”
