OBJECTIVES:

Paclitaxel micellar is the first non-Cremophor-based paclitaxel formulation licensed for the treatment of platinum sensitive ovarian cancer when administered in combination with carboplatin. This study aimed to evaluate the cost effectiveness of paclitaxel micellar in combination with carboplatin versus Cremophor-based paclitaxel in combination with carboplatin for treatment of first relapse patients from an English payer perspective.

METHODS:

A partition survival model was developed based on data from the pivotal trial comparing paclitaxel micellar with Cremophor-based paclitaxel over a lifetime horizon. Health states were defined by pre-progression, progression and death. Efficacy was estimated using treatment specific parametric survival curves fitted to the subgroup of patients with one relapse only. Patient benefits were estimated from a combination of treatment specific and health-state specific utilities. Costs associated with drug acquisition and administration, adverse events, and maintenance therapies were considered. Probabilistic sensitivity analysis (PSA) was used to quantify uncertainty in modelled outcomes. Costs and benefits were discounted at 3.5% per annum.

RESULTS:

Treatment with paclitaxel micellar was estimated to improve patient overall and progression-free survival, translating to an increase in quality adjusted life years (QALYs) gained of 0.08. Increases in total drug acquisition costs were partially offset by reduced administration time and premedication usage for patients treated with paclitaxel micellar, leading to an overall cost increase of £1421 per patient. Increased benefits and costs for patients treated with paclitaxel micellar resulted in an incremental cost-effectiveness ratio (ICER) of £21,632/QALY, with 72% of PSA simulations resulting in a cost-effective ICER at a willingness-to-pay threshold of £30,000.

CONCLUSIONS:

The results of this analysis suggest that paclitaxel micellar is a cost-effective treatment option for patients with first relapse platinum sensitive ovarian cancer. By improving outcomes and reducing administration costs, paclitaxel micellar will reduce the burden imposed by ovarian cancer on both patients and health service delivery.