Cost effectiveness of liposomal doxorubicin vs. paclitaxel for the treatment of advanced AIDS–Kaposi’s sarcoma

Abstract

Objective:

Epidemic Kaposi’s sarcoma (KS) is one of the most common acquired immune deficiency syndrome (AIDS) defining malignancies, a disease with stigmatized clinical features that characterizes the diagnosis of AIDS. This study aims to perform a cost-effectiveness analysis between liposomal doxorubicin and paclitaxel in treating AIDS-KS.

Methods:

A 21 week decision tree analysis was created using a hospital perspective to compare treatment patterns with liposomal doxorubicin and paclitaxel. All costs were calculated in 2011 US dollars and obtained from an academic treatment center. Acquisition costs were obtained from public estimates using wholesale acquisition cost (WAC). Effectiveness was estimated based on a Phase 3 study of liposomal doxorubicin and paclitaxel (Von-Roenn et al.). Adverse events (AEs) associated with treatment and not the disease were included in the analysis. One-way sensitivity analysis was performed to test the robustness of the results.

Results:

Cost minimization analysis showed that treatment with liposomal doxorubicin was $18,125 whereas paclitaxel costs $12,347. After accounting for response rate, the results showed that liposomal doxorubicin costs $39,403 versus $21,661 for paclitaxel. This study has some limitations. Clinical data were derived from different clinical trials. In addition, many assumptions were made.

Conclusion:

Paclitaxel is dominant due to its lower acquisition cost and high response rate. Acquisition cost of liposomal doxorubicin and paclitaxel are significantly different. After accounting for all the factors that contribute to cost and response rate, paclitaxel is more cost effective than liposomal doxorubicin.

Keywords::

• AIDS
• Kaposi’s sarcoma
• Cost effectiveness
• Liposomal doxorubicin
• Paclitaxel

Transparency

Declaration of funding

The authors received no funding for the interpretation or elaboration of this manuscript. All authors participated in the definition of study objectives, development of model, interpretation of results, and wrote and critically reviewed the manuscript. All of the authors have read and approved the content of the entire manuscript, and believe it represents honest work and adheres to ICMJE requirements.

Declaration of financial/other relationships

K.R. has disclosed that she has no significant relationships with or financial interests in any commercial companies related to this study or article. C.A. was awarded grants from AHRQ R18 and CDC Small Community Transformation Grants, and has served as a consultant for Astellas and Bayer. J.B., M.G. and S.S. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article or financial interests in any commercial companies related to this study or article.