Economic Evaluation Of Topotecan In Comparison With Pegylated Liposomal Doxorubicin In The Treatment Of Recurrent Ovarian Cancer In Iran

Ovarian cancer is one of the most prevalent cancer in women. Unfortunately, for patients who relapse after platinum based first-line therapies, only a few second-line agents such as PEGylated liposomal Doxorubicin (PLDH) and Topotecan exist. The aim of this study was to assess the cost-effectiveness of Topotecan in comparison with PLDH in patients with refractory ovarian cancer after platinum based chemotherapy in Iran. Using a 3 state markov model, the analysis was performed from Iranian healthcare system perspective over a life time horizon in a cohort of 1000 patients. The effectiveness was measured as quality adjusted life years (QALYs) which was derived from the literature. Clinical inputs such as adverse events and mortality rates were estimated based on Topotecan phase III trial. Direct medical costs, including drug acquisition cost, hospitalization, and adverse event management were calculated according to hospital records and national tariffs. Costs and outcomes were discounted at 7.2% and 5% ,respectively. Deterministic and probabilistic sensitivity analysis (PSA) were performed to evaluate the robustness of the model. Topotecan was associated with the cost of US$18,828 and 0.53 QALYs. On the other hand, PLDH was associated with the cost of US$ 20,105 and 0.44 QALYs. These differences are mainly due to less disease progression and lower acquisition cost of Topotecan compared to PLDH. As a result, Topotecan was found as dominant strategy and had an 86% chance of being cost-effective in the PSA at the willingness to pay threshold of 1GDP/capita (US$5400). Furthermore, deterministic sensitivity analysis indicated that the model is most sensitive to the acquisition cost of Topotecan as well as PLDH and the time horizon of the model. The results demonstrated that Topotecan is dominant strategy compared to PLDH in the treatment of recurrent ovarian cancer from the perspective of Iranian healthcare system over a life time horizon.