A comparative economic analysis of pegylated liposomal doxorubicin versus topotecan in ovarian cancer in the USA and the UK

Background: Economic information is necessary for rational decision-making in health care. Many European countries require financial impact statements prior to drug approval, and many health care organizations in the USA consider cost-effectiveness when making formulary decisions. We report the findings and discuss the policy implications of an economic evaluation based on an international, randomized controlled trial of salvage therapy for epithelial ovarian cancer, wherein topotecan and pegylated liposomal doxorubicin (PLD) were found to have similar efficacy but differing toxicities. Patients and methods: Direct costs to the payer were estimated for 235 North American and 239 European trial participants who had relapsed or failed platinum-based therapy. Unit costs were obtained from national sources or previously reported economic analyses. Sensitivity analyses were also performed. Results: Total cost per person in the topotecan arm was $12325 (95% CI $9445 to $15415; P > 0.05) higher in the USA-based analysis and $2909 (95% CI $779 to $3415; P < 0.05) higher in the UK-based analysis than for PLD. Pegylated liposomal doxorubicin was cost saving over a wide range of assumptions. The main differences (per person) in toxicity management following PLD compared with topotecan in Europe were for blood transfusions ($1190 versus $181, respectively) and hospitalizations ($1197 versus $280, respectively). In North America, differences were mainly for granulocyte colony stimulating factors ($1936 versus $419 mu g, respectively), erythropoietin ($3493 versus $308, respectively) and blood transfusions ($1346 versus $140, respectively). Conclusions: Policy makers who evaluate pharmacoeconomic studies should consider international differences in health care delivery. Cost assessments based on information obtained from one country may not be relevant for policy makers in a different country.