ScienceDirect.com - Gynecologic Oncology - Economic impact of paclitaxel shortage in patients with newly diagnosed ovarian cancer
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.
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