PMID- 23718933 OWN - NLM STAT- MEDLINE DCOM- 20131112 LR - 20221207 IS - 1095-6859 (Electronic) IS - 0090-8258 (Linking) VI - 130 IP - 3 DP - 2013 Sep TI - Is the progression free survival advantage of concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin in patients with advanced cervical cancer worth the additional cost? A cost-effectiveness analysis. PG - 416-20 LID - S0090-8258(13)00757-9 [pii] LID - 10.1016/j.ygyno.2013.05.024 [doi] AB - OBJECTIVE: The objective of this study is to determine whether concurrent and adjuvant chemoradiation with gemcitabine/cisplatin is cost-effective in patients with stage IIB to IVA cervical cancer. METHODS: A cost-effectiveness model compared two arms of the trial performed by Duenas-Gonzalez et al. [1]: concurrent and adjuvant chemoradiation with gemcitabine/cisplatin (RT/GC+GC) versus concurrent radiation with cisplatin (RT/C). Major adverse events (AEs) and progression free survival (PFS) rates of each arm were incorporated in the model. AEs were defined as any hospitalization including grade 4 anemia, grade 4 neutropenia, and death. Medicare data and literature review were used to estimate costs. Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) were calculated. Sensitivity analyses were performed for pertinent uncertainties. RESULTS: For 10,000 women with locally advanced cervical cancer, the cost of therapy and AEs was $173.9 million (M) for RT/C versus $259.8M for RT/GC+GC. There were 879 additional 3-year progression-free survivors in the RT/GC+GC arm. The ICER for RT/GC+GC was $97,799 per PF-LYS. When the rate of hospitalization was equalized to 4.3%, the ICER for RT/GC+GC exceeded $80,000. The resultant ICER when increasing PFS in the RT/GC+GC arm by 5% was $62,605 per PF-LYS. When the cost of chemotherapy was decreased by 50%, the ICER was below $50,000 at $41,774 per PF-LYS. CONCLUSIONS: Radiation and gemcitabine/cisplatin for patients with stage IIB to IVA cervical cancer are not cost-effective. The increased financial burden of radiation with gemcitabine/cisplatin and associated toxicities appears to outweigh the benefit of increased 3-year PFS and is primarily dependent on chemotherapy drug costs. CI - Copyright (c) 2013 Elsevier Inc. All rights reserved. FAU - Smith, B AU - Smith B AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA. Blair.Smith@osumc.edu FAU - Cohn, D E AU - Cohn DE FAU - Clements, A AU - Clements A FAU - Tierney, B J AU - Tierney BJ FAU - Straughn, J M Jr AU - Straughn JM Jr LA - eng PT - Journal Article DEP - 20130526 PL - United States TA - Gynecol Oncol JT - Gynecologic oncology JID - 0365304 RN - 0W860991D6 (Deoxycytidine) RN - Q20Q21Q62J (Cisplatin) RN - 0 (Gemcitabine) SB - IM MH - Anemia/economics/etiology MH - Antineoplastic Combined Chemotherapy Protocols/*economics/therapeutic use MH - Carcinoma/*economics/therapy MH - Chemoradiotherapy/adverse effects/*economics MH - Chemotherapy, Adjuvant/adverse effects/economics MH - Cisplatin/administration & dosage/economics MH - Cost-Benefit Analysis MH - Deoxycytidine/administration & dosage/analogs & derivatives/economics MH - Disease-Free Survival MH - Female MH - Hospitalization/economics MH - Humans MH - Models, Econometric MH - Neutropenia/economics/etiology MH - Uterine Cervical Neoplasms/*economics/therapy MH - Gemcitabine OTO - NOTNLM OT - Adjuvant chemotherapy OT - Cervical cancer OT - Cost-effectiveness analysis EDAT- 2013/05/31 06:00 MHDA- 2013/11/13 06:00 CRDT- 2013/05/31 06:00 PHST- 2013/02/11 00:00 [received] PHST- 2013/05/17 00:00 [revised] PHST- 2013/05/18 00:00 [accepted] PHST- 2013/05/31 06:00 [entrez] PHST- 2013/05/31 06:00 [pubmed] PHST- 2013/11/13 06:00 [medline] AID - S0090-8258(13)00757-9 [pii] AID - 10.1016/j.ygyno.2013.05.024 [doi] PST - ppublish SO - Gynecol Oncol. 2013 Sep;130(3):416-20. doi: 10.1016/j.ygyno.2013.05.024. Epub 2013 May 26.