Authors' objectives

The authors aimed to assess survival and the cost-effectiveness of treatments for newly diagnosed advanced ovarian cancer.

Searching

The authors searched IDIS (from January 1985 to September 1997), MEDLINE (from January 1980 to September 1997), reviews, textbooks and the reference lists from identified trials. Experts were contacted for additional studies. Only studies published in English were eligible. The authors did not list the search terms used.

Study selection

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

Methods of synthesis

Results of the review

Fifteen trials of first-line therapy for newly diagnosed advanced ovarian cancer, 13 studies on conventional cisplatin-based regimens, 1 study on pacliatxel plus cisplatin, and 1 study of high-dose regimens with transplantation were included in the review. Some of the studies included multiple comparisons so a total of 17 survival curves were calculated with 2,168 participants.

High-dose chemotherapy with autologous haematopoietic rescue was associated with significantly better survival than conventional cisplatin-based chemotherapy without paclitaxel. The mean lifetime survival per woman was 3.05 years for conventional cisplatin-based chemotherapy without paclitaxel (n=1,931), 2.95 years for chemotherapy with paclitaxel plus cisplatin at conventional doses (n=184), and 5.76 years for high-dose chemotherapy with autologous haematopoietic rescue (n=53).

Cost information

The authors collated data on the direct costs from published sources (10 studies published between 1995 and 1997). Using cisplatin-based chemotherapy as a reference term, the incremental cost-effectiveness ratio for high-dose treatments was $25,641 per life-year gained (discounted dollars per discounted life-year gained).

Authors' conclusions

In women with advanced ovarian cancer, high-dose chemotherapy with haematopoietic rescue seems to be more effective and more cost-effective than standard treatments with cisplatin-based regimens at conventional doses.

CRD commentary

The review addressed a clearly defined research question, but only two databases were searched. Unpublished literature was not included and the review was restricted to English language studies. The procedures used to select the studies, assess validity and extract the data were not described in full. The authors suggested that small studies (n<50) were excluded because they are known to be exposed to the risk of publication bias. However, publication bias or other potential biases were not formally assessed.

The authors pooled the data, but did not present a formal heterogeneity analysis for the survival data (although they acknowledged some heterogeneity of the data included in the analysis). This makes it difficult to assess the appropriateness of pooling the data and the clinical applicability of the review's findings. Comparisons were based on just one study for the high-dose plus transplantation and cisplatin plus paclitaxel regimens.

The authors' conclusions were generally supported by the data included in the review. However, it is difficult to assess the validity and applicability of these conclusions given the lack of detail about the included studies and assessment processes, and the lack of studies of some types of treatment.

Implications of the review for practice and research

Practice: The authors suggested that high-dose chemotherapy with haematopoietic rescue may be more effective and cost-effective than conventional cisplatin-based chemotherapy regimens for patients with newly diagnosed advanced ovarian cancer.

Research: The authors did not state any implications for further research, although they noted that there were few large studies on high-dose regimens and cisplatin plus paclitaxel.

Bibliographic details

Messori A, Trippoli S, Becagli P, Tendi E. Treatments for newly diagnosed advanced ovarian cancer: analysis of survival data and cost-effectiveness evaluation. Anti-Cancer Drugs 1998; 9(6): 491-502. [PubMed: 9877236]

Other publications of related interest

1. Messori A. Survival curve fitting using the Gompertz function: a methodology for conducting cost-effectiveness analyses on mortality data. Comput Meth Progr Biomed 1997;52:157-64. 2. Simes RJ. Confronting publication bias: a cohort design for meta-analysis. Stat Med 1987;6:11-29.

Indexing Status

Subject indexing assigned by NLM

MeSH

Antineoplastic Combined Chemotherapy Protocols /economics /therapeutic use; Area Under Curve; Blood Component Transfusion /economics; Clinical Trials as Topic; Cost-Benefit Analysis /economics; Direct Service Costs; Female; Humans; Ovarian Neoplasms /economics /mortality /therapy; Sensitivity and Specificity; Survival Analysis

AccessionNumber

11999003618

Database entry date

30/06/2004

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.