PLDH FOR OVARIAN CANCER
A systematic review and economic evaluation of pegylated liposomal doxorubicin hydrochloride for ovarian cancer
BackgroundThe aim of this systematic review was to examine the clinical effectiveness and cost-effectiveness of intravenous PLDH as second-line treatment for advanced ovarian cancer after failure of first-line platinum-based therapy.
The main results of this review suggested that there is little RCT evidence for assessment of the effectiveness of PLDH as second-line therapy for advanced ovarian cancer. Data from only one RCT was included in the final assessment of clinical effectiveness, and only two economic evaluations relevant to the UK NHS were identified and included in the cost-effectiveness assessment.
The evidence suggested that there were no differences between PLDH and topotecan in the main clinical outcomes. However, significant differences were observed in the incidence of adverse events. The clinical significance of these findings was not discussed. Overall, the clinical effects of PLDH could at best be described as modest, however, the only other comparator considered in this review offered no real advantages. If anything, PLDH offered possible clinical advantages over topotecan due to fewer adverse events.
Based on existing data, PLDH is less costly than topotecan. When effectiveness was based on survival duration, PLDH had a high probability of being cost-effective. However, differences between the two therapies are likely to exist in overall HRQoL, which, when expressed in terms of QALYs, could alter these cost-effectiveness results markedly.Conducted by: C Forbes1, J Wilby1, G Richardson2, M Sculpher2, L Mather1, R Riemsma1
1. NHS Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York
Further detailsProject page on HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal 45: Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for the treatment of advanced ovarian cancer (review of TA28, TA45 and TA55 (for relapsed disease only)). London: National Institute for Clinical Excellence; 2002. NB: This guidance is replaced by TA91 Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan (review).
PublicationsForbes C, Wilby J, Richardson G, Mather L, Sculpher M, Riemsma R. A rapid and systematic review of the clinical effectiveness and cost effectiveness of pegylated liposomal doxorubicin hydrochloride for ovarian cancer. Health Technol Assess. 2002;6(23):1-143
PresentationsForbes C, Wilby J, Riemsma R. Evidence to support the clinical and cost effectiveness of Hycamtin, GSK (topotecan) and Caelyx, Schering-Plough (pegylated liposomal doxorubicin hydrochloride) for advanced ovarian cancer. NICE Annual Conference; 2002 December; Birmingham, UK
Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process