Economic Evaluation of Paclitaxel Plus Carboplatin Versus Paclitaxel Plus Ifosfamide in the Management of Uterine Carcinosarcoma
AuthorAgu, Uchechukwu Samuel
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PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
EmbargoRelease after 11/30/2026
AbstractObjective: Recent evidence has supplanted PC over PI as the preferred chemotherapeutic option in UCS. We aimed to examine the economic benefit of PC by performing a cost-effectiveness and cost-utility analysis of PC compared to PI from the US payer perspective using a hypothetical population of chemotherapy naïve UCS patients. Methods: We developed a 3-state (progression-free, progressed, death) partitioned survival model and used digitized progression-free (PFS) and overall survival (OS) Kaplan Meier plots to recreate individual patient data. These were evaluated with different parametric distributions to determine the best-fitting distributions. Cost data were obtained from Redbook, CMS physician fee schedule, and literature; inflated to 2023 equivalents. Primary outcomes include differential cost, life-year (LY), quality-adjusted life-year (QALY), cost-effectiveness ratio (DCER), and cost-utility ratio (DCUR). One-way sensitivity analysis (OWSA) determined the parameters with the greatest impact on model results, while probabilistic sensitivity analysis (PSA) examined the robustness of the model. A time horizon of 72 months and a willingness to pay threshold of an incremental $50,000 per QALY gained (QALYg) were adopted. A 3% per year discount was applied to costs. Results: The Gompertz distribution proved to be the best fit for the PI arm in both the PFS and OS, whereas the generalized gamma (PFS) and log-normal (OS) were identified as the optimal fits for the PC arm. The base case result showed that PI accumulated a total cost of $89,177 with a 1.09 LY and 0.83 QALY. In contrast, the PC accumulated a total cost of $34,527 with 2.22 LY and 1.69 QALY. Compared to PI, PC was shown to be cost saving by $-54,650, at a differential LY of 1.13 and an incremental QALY of 0.86, yielding DCER savings of $-48,363/QALYg and DCUR savings of $-63,547/QALYg. Sensitivity analyses, including OWSA and confirmed by PSA, highlighted the pivotal impact of the progressed disease utility of PC on the model results, while the administration cost of PI significantly influenced incremental cost. Conclusion: In a population of chemotherapy naïve UCS patients, PC offers improved survival outcomes at lower costs compared to PI.
Degree ProgramGraduate College