Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer?

Academic Article

Abstract

  • OBJECTIVE: Recurrent cervical cancer has a poor prognosis despite aggressive treatment. We evaluate the comparative-effectiveness of four management strategies in recurrent cervix cancer incorporating risk prognostication categories derived from pooled collaborative group trials: 1) standard doublet chemotherapy; 2) selective chemotherapy (home hospice with no chemotherapy for poorest prognosis patients with remainder receiving standard doublet chemotherapy); 3) single-agent chemotherapy with home hospice; and 4) home hospice. METHODS: A cost-effectiveness decision model was constructed. Survival reduction of 24% was assumed for single-agent chemotherapy and 40% for hospice only compared to standard doublet chemotherapy. Overall survival and strategy cost for each arm were modeled as follows: standard doublet chemotherapy 8.9 months ($33K); selective chemotherapy 8.7 months ($29K); single-agent chemotherapy with home hospice 6.7 months ($16K); and home hospice alone 5.3 months ($11K). Base case analysis assumed equal quality of life (QOL). Sensitivity analyses assessed model uncertainties. RESULTS: Standard doublet chemotherapy for all is not cost-effective compared to selective chemotherapy with an incremental cost-effectiveness ratio (ICER) of $276K per quality-adjusted life-year (QALY). Sensitivity analysis predicted that a 90% improvement in survival is required before standard doublet chemotherapy is cost-effective in the poorest prognosis patients. Selective chemotherapy is the most cost-effective strategy compared to single-agent chemotherapy with home hospice with an ICER of $78K/QALY. Chemotherapy containing regimens become cost-prohibitive with small decreases in QOL. CONCLUSIONS: Supportive care based treatment strategies are potentially more cost-effective than the current standard of doublet chemotherapy for all patients with recurrent cervical cancer and warrant prospective evaluation.
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    Keywords

  • Cost-effectiveness, Decision analysis, Recurrent cervix cancer, Selective chemotherapy, Supportive care, Cost-Benefit Analysis, Female, Health Care Costs, Hospice Care, Humans, Neoplasm Recurrence, Local, Quality of Life, Uterine Cervical Neoplasms
  • Digital Object Identifier (doi)

    Author List

  • Phippen NT; Leath CA; Miller CR; Lowery WJ; Havrilesky LJ; Barnett JC
  • Start Page

  • 317
  • End Page

  • 322
  • Volume

  • 130
  • Issue

  • 2