***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose .To provide a practical quantitative tool for appraising the quality of  cost-effectiveness ( CE ) studies . Methods .A committee comprised of health economists selected a set of criteria for the instrument from an item pool . Data collected with a conjoint analysis survey on 120 international health economists were used to estimate weights for each criterion with a r and om effects regression model . To vali date the grading system , a survey was sent to 60 individuals with health economics expertise . Participants first rated the quality  of three CE studies  on a visual analogue scale , and then evaluated each study using the  grading system . Spearman rho and Wilcoxon tests were used to detect convergent validity and analysis of covariance ( ANCOVA ) for discriminant validity . Agreement between the global rating by experts and the grading system was also examined . Results .Sixteen criteria were selected . Their coefficient estimates ranged from 1.2 to 8.9 , with a sum of 93.5 on a 100-point scale . The only insignificant criterion was “ use of subgroup analyses . ” Both convergent validity and discriminant validity of the grading system were shown by the results of the Spearman rho ( correlation coefficient = 0.78 , P < 0.0001 ) , Wilcoxon test ( P = 0.53 ) , and ANCOVA ( F3,146 = 5.97 , P = 0.001 ) . The grading system had good agreement with global rating by experts . Conclusions . The instrument appears to be simple , internally consistent , and valid for measuring the perceived quality of CE studies . Applicability for use in clinical and re source allocation decision-making deserves further study Abstract Objective : To assess the economic impact of two polychemotherapy regimens for patients with advanced ovarian cancer from the perspective of the Belgian health insurance and financing system . Design : An economic evaluation was integrated in an intergroup r and omised controlled trial ( EORTC 55931 ) in which patients were r and omised to receive the new treatment of paclitaxel and cisplatin or the st and ard therapy of cyclophosphamide and cisplatin . Data on the use of medical re sources were collected prospect ively for the 231 European Organization for Research and Treatment of Cancer ( EORTC ) patients in the trial and costs were valued by using unit prices . The outcome for the economic evaluation was mean survival time as determined by the so-called restricted means method , with the time point of restriction fixed by statistical criteria . A correction of censoring of the cost data collected in the trial was also performed . Main outcome measures and results : The paclitaxel and cisplatin group experienced a statistically significant improvement in mean survival time of 4 months , which was associated with an increase in the average total cost per patient of 6795 euros ( EUR ; 1998 values ) , when costs were assessed over the same period as the gain in mean survival time . This corresponds to a point estimate of the incremental cost-effectiveness ratio of EUR20 385 per life-year gained . The impact of uncertainty was assessed by using a bias-corrected and accelerated bootstrap method with 5000 re sample s , and the final results of the analysis are expressed in terms of a cost-effectiveness acceptability curve . Conclusions : The present economic evaluation has shown that the substitution of paclitaxel for cyclophosphamide in the chemotherapy regimen for women with advanced ovarian cancer leads to a significant improvement in patient survival , which is associated with an increase in costs for the Belgian health insurance system PURPOSE To determine the side effects and feasibility of cisplatin and carboplatin each in combination with paclitaxel as front-line therapy in advanced epithelial ovarian cancer . PATIENTS AND METHODS Patients were r and omly allocated to receive paclitaxel 175 mg/m(2 ) intravenously as a 3-hour infusion followed by either cisplatin 75 mg/m(2 ) or carboplatin ( area under the plasma concentration-time curve of 5 ) , both on day 1 . The schedule was repeated every 3 weeks for at least six cycles . Women allocated to paclitaxel-cisplatin were admitted to the hospital , whereas the carboplatin regimen was administered to out patients . RESULTS A total of 208 eligible patients were r and omized . Both regimens could be delivered in an optimal dose and without significant delay . Paclitaxel-carboplatin produced significantly less nausea and vomiting ( P : < .01 ) and less peripheral neurotoxicity ( P : = .04 ) but more granulocytopenia and thrombocytopenia ( P : < .01 ) . The overall response rate in 132 patients with measurable disease was 64 % ( 84 of 132 patients ) , and in patients with elevated CA 125 levels at start , it was 74 % ( 132 of 178 patients ) . With a median follow-up time of 37 months , the median progression-free survival time of all patients was 16 months and the median overall survival time was 31 months . The small number of patients entered onto the study caused wide confidence intervals ( CIs ) around the hazards ratio for progression-free survival of paclitaxel-carboplatin compared with paclitaxel-cisplatin ( hazards ratio , 1.07 ; 95 % CI , 0.78 to 1.48 ) and did not allow conclusions about efficacy . CONCLUSION Paclitaxel-carboplatin is a feasible regimen for out patients with ovarian cancer and has a better toxicity profile than paclitaxel-cisplatin BACKGROUND Despite considerable improvement in the treatment of advanced ovarian cancer , the optimization of efficacy and tolerability remains an important issue . Therefore , we performed a r and omized , phase III non-inferiority trial comparing paclitaxel plus cisplatin ( PT ) with paclitaxel plus carboplatin ( TC ) in patients with advanced ovarian cancer . METHODS A total of 798 patients with International Federation of Gynecology and Obstetrics stage IIB-IV were r and omly assigned to receive six courses of either PT or TC at 3-week intervals . The primary endpoint was the proportion of patients without progression at 2 years . Secondary endpoints included toxicity , response to treatment , quality of life , and overall and progression-free survival time . Quality of life was evaluated using the European Organization for Research and Treatment of Cancer quality -of-life question naire (QLQ)-C30 , version 2.0 . Survival curves were calculated using the Kaplan-Meier method , and hazard ratios were estimated using the Cox proportional hazards model . RESULTS The proportion of patients without progression at 2 years was not statistically significantly different between the two treatment arms ( 40.0 % for PT versus 37.5 % for TC , difference = 2.5 % , one-sided 95 % confidence interval [ CI ] = - infinity to 8.2 % ) . Median progression-free survival time in the TC arm ( 17.2 months , 95 % CI = 15.2 to 19.3 months ) and the PT arm ( 19.1 months , 95 % CI = 16.7 to 21.5 months ) were also not statistically significantly different ; the same was true of median overall survival time ( 43.3 months , 95 % CI = 37.2 to 47.8 months versus 44.1 months , 95 % CI = 40.2 to 49.4 months , for the TC and PT arms , respectively ) . The TC regimen was associated with a higher frequency of hematologic toxicity , but a lower frequency of gastrointestinal and neurologic toxicity , than the PT regimen . Mean global quality -of-life scores at the end of treatment were statistically significantly better in the TC arm than in the PT arm ( 65.25 versus 51.97 , respectively ; difference = -13.28 , 95 % CI = -18.88 to -7.68 ) . CONCLUSION The TC regimen achieved comparable efficacy to the PT regimen but was associated with better tolerability and quality of life , and should , therefore , be considered as an important alternative for st and ard first-line chemotherapy in patients with advanced ovarian cancer OBJECTIVE Compared with every-3-week paclitaxel ( q3 T ) plus carboplatin , dose-dense weekly paclitaxel ( ddT ) plus carboplatin improved the survival of ovarian cancer patients . We performed a cost analysis comparing these two regimens . METHODS Using a Markov decision model , an acceptable incremental cost-effectiveness ratio ( ICER ) per progression-free life-year saved ( PFLYS ) was estimated . Cost of drugs , growth colony-stimulating factors , and transfusions were derived from Medicare reimbursement data . Survival and rates of complications were estimated based on the clinical trial . RESULTS Using a body weight and surface area of an average woman age 63 , the estimated cost per cycle of ddT was $ 107 vs. $ 80 for q3 T . The costs per cycle of combination chemotherapy including treatment administration were $ 873 for ddT and $ 535 for q3 T . With a median progression-free survival ( PFS ) of 28 months with ddT vs. 17.2 months with q3 T , the ICER was $ 5809 per PFLYS for ddT compared with q3 T arm . Using a maximum ICER of $ 100,000 per LYS as cost-effective threshold , the ddT regimen was cost-effective . The ICER was most sensitive to the hazard rate for difference in PFS between the two regimens . A 4-month difference in PFS result ed in a $ 1200 change of ICER per PFLYS . The ICER was also sensitive to overall survival difference , rate of hematological toxicity , and rate of discontinuation . CONCLUSIONS In this economic model , dose-dense weekly paclitaxel is a cost-effective treatment option for advanced ovarian cancer PURPOSE In r and omized trials the combination of cisplatin and paclitaxel was superior to cisplatin and cyclophosphamide in advanced-stage epithelial ovarian cancer . Although in nonr and omized trials , carboplatin and paclitaxel was a less toxic and highly active combination regimen , there remained concern regarding its efficacy in patients with small-volume , resected , stage III disease . Thus , we conducted a noninferiority trial of cisplatin and paclitaxel versus carboplatin and paclitaxel in this population . PATIENTS AND METHODS Patients with advanced ovarian cancer and no residual mass greater than 1.0 cm after surgery were r and omly assigned to receive cisplatin 75 mg/m2 plus a 24-hour infusion of paclitaxel 135 mg/m2 ( arm I ) , or carboplatin area under the curve 7.5 intravenously plus paclitaxel 175 mg/m2 over 3 hours ( arm II ) . RESULTS Seven hundred ninety-two eligible patients were enrolled onto the study . Prognostic factors were similar in the two treatment groups . Gastrointestinal , renal , and metabolic toxicity , as well as grade 4 leukopenia , were significantly more frequent in arm I. Grade 2 or greater thrombocytopenia was more common in arm II . Neurologic toxicity was similar in both regimens . Median progression-free survival and overall survival were 19.4 and 48.7 months , respectively , for arm I compared with 20.7 and 57.4 months , respectively , for arm II . The relative risk ( RR ) of progression for the carboplatin plus paclitaxel group was 0.88 ( 95 % confidence interval [ CI ] , 0.75 to 1.03 ) and the RR of death was 0.84 ( 95 % CI , 0.70 to 1.02 ) . CONCLUSION In patients with advanced ovarian cancer , a chemotherapy regimen consisting of carboplatin plus paclitaxel results in less toxicity , is easier to administer , and is not inferior , when compared with cisplatin plus paclitaxel INTRODUCTION Paclitaxel plus cisplatin is considered to be the st and ard first-line therapy for advanced ovarian cancer . Previous to this study , economic data on this combination result ed from r and omised clinical trials ( RCTs ) . Therefore , the objective of this study was to compare the clinical and economic outcomes associated with paclitaxel-cisplatin ( PC ) and cyclophosphamide-cisplatin ( CC ) regimens using a pragmatic perspective based on daily clinical practice in a French university hospital . METHOD A retrospective cost-effectiveness analysis , from the hospital-payer perspective , was carried out as a before-after case study in fifty-nine consecutive women with verified International Federation of Gynaecology and Obstetrics ( FIGO ) stage II , III or IV ovarian cancer treated between 1995 and 2000 .  Median overall survival ( OS ) was used as the primary endpoint . The quality -adjusted time was assessed by the quality -adjusted time without symptoms or toxicity ( Q-TWiST ) method . Direct medical costs were collected for each patient . Monetary values for French prices in the year 2000 were used and converted to US dollars using an exchange rate of USD 1 = 7 French francs . Several univariate sensitivity analyses were carried out varying unit costs , medical practice s and administration of paclitaxel . RESULTS The incremental cost of the  PC regimen was USD 10,716 per patient . OS and quality -adjusted time were improved by 10.8 and 9.3 months with the PC regimen . The cost per life-year gained and per added QALY were USD 11,907 and US 
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For second-line treatment , the use of platinum – paclitaxel combination or platinum monotherapy was cost-effective compared with platinum monotherapy or best supportive care , respectively , in women with recurrent platinum-sensitive disease .
Conclusions Despite varying method ological approaches and multiple sources for cost and effectiveness inputs , this systematic review demonstrated that st and ard platinum – taxane combination chemotherapy for first-line treatment was most cost-effective .
There was unanimous agreement that bevacizumab was not a cost-effective front-line therapy compared with platinum – taxane combination for the overall ovarian cancer population , though its use in the high-use population may yield better value .
For second-line treatment , platinum-based chemotherapy remained cost-effective among patients with recurrent platinum-sensitive disease , while there was limited evidence to conclude the most valuable treatment alternative among patients with recurrent platinum-resistant disease .