PCN23 Cost-Effectiveness Analysis of Topotecan, Pegylated Liposomal Doxorubicin Hydrochloride, and paclitaxel As Second-LINE Chemotherapy in the Treatment of Platinum-Resistant Ovarian Cancer in Iran

Ovarian cancer is the eighth most prevalent cancer in Iranian women with the incidence rate of 3.9 per 100000 and most of the patients are younger than 45 years. The aim of this study was to determine the cost-effectiveness of Topotecan, PLDH and Paclitaxel as second-line therapies to treat platinum-resistant/refractory ovarian cancer patients in Iran. A Markov model with 4 states was developed to represent the medical and economic consequences of the administration of Topotecan, PLDH and Paclitaxel with the perspective of payer. Time horizon of the analysis was 3 years. A cohort of 1000 patients with platinum-resistant epithelial ovarian cancer who had failed the first-line chemotherapy treatment was utilized to assess the incremental cost-utility of Topotecan, PLDH and Paclitaxel. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Overall survival (OS) and progression-free survival (PFS) data were derived from the literature and cost data were retrieved from local experts and national tariffs. Discount rate of 7.5% and 5% was employed to costs and outcomes, respectively. Both deterministic and probabilistic sensitivity analysis (PSA) were conducted to show the robustness of the model. The total cost per patient for Topotecan, PLDH and Paclitaxel were 702،289،993, 749،920،149 and 808،151،434 (rial) respectively. The discounted QALYs were 0.53, 0.44 and 0.32 for Topotecan, PLDH and Paclitaxel respectively. From the payer perspective, treatment with Topotecan will result in 0.09 higher QALYs and cost saving at least equal to 47،630،156 rials for each patient. Thus Topotecan was the cost-effective option among the arms of the study. Results from the PSA showed that in 86% of the simulations, Topotecan was dominant compared to the other arms. Results showed that Topotecan is the most cost effective option in treatment of patients with Platinum-resistant Ovarian Cancer. The sensitivity analysis further indicated the robustness of the model.