| Abstract: |
Purpose The ASCO value framework allows physicians and patients tocompare the relative value of novel treatments. Our aim was to assess the value of three frontline ovarian cancer therapies by using this framework. Methods From phase III, randomized controlled clinical trial (RCT) data, the net health benefits (NHBs) for three frontline ovarian cancer treatment options-dose-dense paclitaxel (Japanese Gynecologic Oncology Group study JGOG 3016), intraperitoneal (IP)/ intravenous (IV) chemotherapy (Gynecologic OncologyGroup[GOG]studyGOG172), and concurrent plus maintenance bevacizumab (GOG 218 and the Seventh International Collaborative Ovarian Neoplasm study [ICON7])-were calculated. The ASCO value framework calculates the NHB by using six criteria: clinical benefit, toxicity, tail of the curve, symptom palliation, treatment-free interval, and quality of life. Clinical benefit calculation uses ASCO-assigned importance weights for overall survival and progressionfree survival. The maximum possible NHB points is 180. NHBs were presented alongside the drug-acquisition cost (DAC) of each therapy. A benefit-cost ratio of NHB points per additional cost was calculated. Results The NHB of dose-dense paclitaxel was 38, at an additional cost of $16 per cycle. IP cisplatin/IV + IP paclitaxel received 29 NHB points, at an additional cost of $1, 629 per cycle. Concurrent plus maintenance bevacizumab received 24NHBpoints, at an additional cost of $7, 581 per cycle(GOG218) or sixNHBpoints ($3, 790 per cycle; ICON7). The ratios of NHB points-to-dollar were as follows: dose-dense paclitaxel, 2.4 (highest); IP chemotherapy, 0.018; and bevacizumab, 0.003 (lowest). Conclusion Using theASCOvalue framework, weconstructed value snapshots of three major frontline therapeutic options in ovarian cancer. Dose-dense paclitaxel provided the highest additional value when analysis accounted forNHBand cost. However, additional research is needed to include individual patient preferences and provide personalized value assessments. Copyright © 2018 American Society of Clinical Oncology. All rights reserved. |
