Trabectedin in the treatment of metastatic soft tissue sarcoma: cost-effectiveness, cost-utility and value of information

Background: To assess the cost-effectiveness of trabectedin compared with end-stage treatment (EST) after failure with anthracycline and/or ifosfamide in metastatic soft tissue sarcoma (mSTS). Design: Analysis was carried out using a probabilistic Markov model with trabectedin -> EST and EST arms, three health states (stable disease, progressive disease and death) and a lifetime perspective (3% annual discount rate). Finnish resources (drugs, mSTS, adverse events and travelling) and costs (year 2008) were used. Efficacy was based on an indirect comparison of the STS-201 and European Organisation for Research and Treatment of Cancer trials. QLQ-C30 scale scores were mapped to 15D, Short Form 6D and EuroQol 5D utilities. The outcome measures were the cost-effectiveness acceptability frontier, incremental cost per life year gained (LYG) and quality-adjusted life year (QALY) gained and the expected value of perfect information (EVPI). Results: Trabectedin -> EST was associated with 14.0 (95% confidence interval 9.1-19.2) months longer survival, (sic)36 778 higher costs ((sic)32 816 using hospital price for trabectedin) and (sic)31 590 ((sic)28 192) incremental cost per LYG with an EVPI of (sic)3008 ((sic)3188) compared with EST. With a threshold of (sic)50 000 per LYG, trabectedin -> EST had 98.5% (98.2%) probability of being cost-effective. The incremental cost per QALY gained with trabectedin -> EST was (sic)42 633-47 735 ((sic)37 992-42 819) compared with EST. The results were relatively insensitive to changes. Conclusion: Trabectedin is a potentially cost-effective treatment of mSTS patients.