Journal of Clinical Oncology, Vol 15, 1000-1007, Copyright © 1997 by American Society of Clinical Oncology
Resource implications of palliative chemotherapy for ovarian cancer
C Doyle, M Stockler, M Pintilie, P Panesar, P Warde, J Sturgeon and AM Oza
Department of Medicine, University of Toronto, Canada.
PURPOSE: To describe the costs and outcomes of palliative chemotherapy in
women with recurrent and refractory ovarian cancer from the perspective of
a health care provider. PATIENTS AND METHODS: A retrospective study of 40
consecutive women who started second- or third-line chemotherapy for
recurrent or refractory ovarian cancer between 1989 and 1992. Resource
utilization from the commencement of second- or third-line chemotherapy
until death or last follow-up evaluation was determined from a detailed
chart review. All elements of care were recorded, including inpatient
admissions, outpatient visits, chemotherapy drugs, nonchemotherapy drugs,
radiation therapy, surgical procedures, investigations, and home care.
Costs calculated using the hotel-approximation method are expressed in 1994
Canadian dollars. Actuarial estimates of cost and survival were used to
account for censored observations. RESULTS: After a minimum follow-up
period of 24 months, 36 of 40 women had died. The median survival duration
of the group was 1.1 years from study entry and 1.7 years from first
relapse. The women received a median of two regimens of chemotherapy
(range, one to four) from study entry. They spent a median of 33 days as
hospital inpatients (mean, 46; range, 0 to 185); 58% of these inpatient
days were for symptomatic management and 32% were for chemotherapy. The
mean cost per patient was $53,000 (median, $36,600; range, $4,800 to
$162,900). The relationship between cost and survival duration was not
linear--the cost per year was lowest for those who lived longest. Inpatient
admissions, chemotherapy drugs, and outpatient visits accounted for 62%,
21%, and 8% of the total cost, respectively. The total costs attributable
to chemotherapy were $24,000 (45% of total costs) and the total costs
attributable to supportive care were $23,000 (43% of total costs).
CONCLUSION: These data illustrate the cost of palliative management of
recurrent and refractory ovarian cancer, which must be considered in the
context of quality and duration of survival. They indicate the potential to
improve cost efficiency by improving resource management, for example, by
shifting from inpatient to outpatient chemotherapy, everything else being
equal.
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