Cost-utility assessment of amifostine as first-line therapy for ovarian cancer

Nearly 27,000 female patients were diagnosed with ovarian cancer in the United States in 1997. While chemotherapeutic agents are effective in prolonging the time to progression of disease, concerns exist over treatment- related toxicities. In addition to considerations related to effectiveness, the decision to prescribe new cytoprotective agents requires consideration of costs and cost-effectiveness. The objective of this study was to describe cost-utility estimates of a new supportive care agent, amifostine, and to illustrate these issues for patients with ovarian cancer. The phase III Food and Drug Administration (FDA) licensing trial found that pretreatment with amifostine prior to each cycle of chemotherapy resulted in reduction of cumulative toxicities with cyclophosphamide and cisplatinum. While amifostine use is approximately $3,146 more per patient, after adjustment for direct medical costs and potential health status changes from reductions in hematologic toxicity, neurotoxicity, and nephrotoxicity, its use was estimated to cost $36,161 in direct medical costs per quality-adjusted life year saved. Sensitivity analyses indicated that cost-effectiveness estimates of amifostine therapy ranged from $25,474 to $78,574. Based on the phase III FDA licensing trial, amifostine use is associated with a favorable cost- utility profile that is in the range associated with widely used cancer therapeutic and supportive care agents. The decision to use (or not use) amifostine in conjunction with cisplatin and cyclophosphamide for women with ovarian cancer should be based on clinical, not economic, considerations.