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

Publication ,  Journal Article
Phippen, NT; Leath, CA; Miller, CR; Lowery, WJ; Havrilesky, LJ; Barnett, JC
Published in: Gynecol Oncol
August 2013

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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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

August 2013

Volume

130

Issue

2

Start / End Page

317 / 322

Location

United States

Related Subject Headings

  • Uterine Cervical Neoplasms
  • Quality of Life
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Humans
  • Hospice Care
  • Health Care Costs
  • Female
  • Cost-Benefit Analysis
  • 3215 Reproductive medicine
 

Citation

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Phippen, N. T., Leath, C. A., Miller, C. R., Lowery, W. J., Havrilesky, L. J., & Barnett, J. C. (2013). Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer? Gynecol Oncol, 130(2), 317–322. https://doi.org/10.1016/j.ygyno.2013.05.019
Phippen, Neil T., Charles A. Leath, Caela R. Miller, William J. Lowery, Laura J. Havrilesky, and Jason C. Barnett. “Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer?Gynecol Oncol 130, no. 2 (August 2013): 317–22. https://doi.org/10.1016/j.ygyno.2013.05.019.
Phippen NT, Leath CA, Miller CR, Lowery WJ, Havrilesky LJ, Barnett JC. Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer? Gynecol Oncol. 2013 Aug;130(2):317–22.
Phippen, Neil T., et al. “Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer?Gynecol Oncol, vol. 130, no. 2, Aug. 2013, pp. 317–22. Pubmed, doi:10.1016/j.ygyno.2013.05.019.
Phippen NT, Leath CA, Miller CR, Lowery WJ, Havrilesky LJ, Barnett JC. Are supportive care-based treatment strategies preferable to standard chemotherapy in recurrent cervical cancer? Gynecol Oncol. 2013 Aug;130(2):317–322.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

August 2013

Volume

130

Issue

2

Start / End Page

317 / 322

Location

United States

Related Subject Headings

  • Uterine Cervical Neoplasms
  • Quality of Life
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Humans
  • Hospice Care
  • Health Care Costs
  • Female
  • Cost-Benefit Analysis
  • 3215 Reproductive medicine