***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: BACKGROUND Economic information is necessary for rational decision-making in health care . Many European countries require financial impact statements prior to drug approval , and many health care organizations in the USA consider cost-effectiveness when making formulary decisions . We report the findings and discuss the policy implication s of an economic evaluation based on an international , r and omized controlled trial of salvage therapy for epithelial ovarian cancer , wherein topotecan and pegylated liposomal doxorubicin ( PLD ) were found to have similar efficacy but differing toxicities . PATIENTS AND METHODS Direct costs to the payer were estimated for 235 North American and 239 European trial participants who had relapsed or failed platinum-based therapy .  Unit costs were obtained from national sources or previously reported economic analyses . Sensitivity analyses were also performed . RESULTS Total cost per person in the topotecan arm was 12,325 dollars ( 95 % CI 9445 dollars to 15,415 dollars ; P > 0.05 ) higher in the USA-based analysis and 2909 dollars ( 95 % CI 779 dollars to 3415 dollars ; P < 0.05 ) higher in the UK-based analysis than for PLD . Pegylated liposomal doxorubicin was cost saving over a wide range of assumptions . The main differences ( per person ) in toxicity management following PLD compared with topotecan in Europe were for blood transfusions ( 1190 dollars versus 181 dollars , respectively ) and hospitalizations ( 1197 dollars versus 280 dollars , respectively ) . In North America , differences were mainly for granulocyte colony stimulating factors ( 1936 dollars versus 419 dollars micro g , respectively ) , erythropoietin ( 3493 dollars versus 308 dollars , respectively ) and blood transfusions ( 1346 dollars versus 140 dollars , respectively ) . CONCLUSIONS Policy makers who evaluate pharmacoeconomic studies should consider international differences in health care delivery . Cost assessment s based on information obtained from one country may not be relevant for policy makers in a different country BACKGROUND In the CALYPSO trial , carboplatin-pegylated liposomal doxorubicin ( CD ) demonstrated superior therapeutic index versus carboplatin-paclitaxel ( CP ) in patients with recurrent ovarian cancer . This paper reports the health-related quality of life ( HRQoL ) findings . MATERIAL S AND METHODS HRQoL was measured with the EORTC QoL-QC30 question naire and OV28 ovarian cancer module . Mean change scores from baseline in HRQoL subscales ( five functional scales and global health status ) in each arm and the proportion of patients improved or worsened were calculated every 3 months until 12 months . RESULTS Compliance was 90 % at baseline and 76 % , 64 % , 57 % at 3 , 6 , and 9 months , respectively . Baseline HRQoL showed already impaired global scores ( mean 62/100 ) and considerable symptom burden ( 90 % of patients reporting nonzero scores ) . Global QoL and abdominal symptom scores improved over time in both arms ; at 6 months , 36 % of patients met criteria for improved symptoms . Treatment with CD result ed in less peripheral neuropathy ( 9.8 versus 24.2 ) , fewer other chemotherapy side-effects ( 9.5 versus 16.2 ) , and less impact on body image ( 3.8 versus 10.4 ) versus CP ( all P<0.02 ) at 6 months . CONCLUSIONS These patient-reported outcomes confirm the overall lower toxicity of CD versus CP . The improved disease-related outcomes achieved with CD were not at the expense of BACKGROUND Cost-effectiveness/cost-utility analyses are increasingly needed to inform decisions about care . Algorithms have been developed using the Functional Assessment of Cancer Therapy ( FACT ) quality of life instrument to estimate utility weights for cost analyses . This study was design ed to compare these algorithms in the setting of ovarian cancer . METHODS GOG-0152 was a 550-patient r and omized phase III trial of interval cytoreduction , and GOG-0172 was a 415-patient r and omized phase III trial comparing intravenous versus intraperitoneal therapy among women with advanced ovarian cancer .  QOL data were collected via the FACT at four time points in each study . Two published mapping algorithms ( Cheung and Dobrez ) and a linear transformation method were applied to these data . The agreement between measures was assessed by the concordance correlation coefficient ( r(CCC ) ) , and paired t-tests were used to compare means . RESULTS While agreement between the estimation algorithms was good ( ranged from 0.72 to 0.81 ) , there were statistically significant ( p<0.001 ) and clinical ly meaningful differences between the scores : mean scores were higher with Dobrez than with Cheung or the linear transformation method . Scores were also statistically significantly different ( p<0.001 ) between studies . CONCLUSIONS In the absence of prospect ively collected utility data , the use of mapping algorithms is feasible , however , the optimal algorithm is not clear . There were significant differences between studies , which highlight the need for validation of these algorithms in specific setting s. If cost analyses incorporate mapping algorithms to obtain utility estimates , investigators should take the variability into account BACKGROUND We have continued to monitor the survival of patients r and omised in a previously reported multicentre phase III study of topotecan versus paclitaxel in patients with advanced epithelial ovarian cancer who had failed one prior platinum-based regimen . PATIENTS AND METHODS Patients with bidimensionally measurable disease were r and omised to topotecan  ( 1.5 mg/m(2)/day for 5 days ) or paclitaxel ( 175 mg/m(2)/day as a 3-h infusion ) every 21 days . Patients were eligible for treatment with the alternate therapy at third line . The European Organisation for Research and Treatment of Cancer Quality of Life ( EORTC QOL)-C30 question naire was also used to measure eight symptoms at baseline and during each course ( pain , anorexia , diarrhoea , fatigue , nausea and vomiting , dyspnea , constipation and insomnia ) . RESULTS A total of 226 patients were evaluable for response . Demographic characteristics were similar in both treatment groups , as were results of the EORTC QOL-30 question naire . For the topotecan group , median time to progression was 18.9 weeks ( range < 1 to 92.6 + weeks ; 25 % censored ) , and , for paclitaxel , 14.7 weeks ( range < 1 to 137.3 + weeks ; 12.3 % censored ) ; P = 0.076 . At 4 years post-r and omisation , median survival in the topotecan group was 63.0 weeks ( range < 1 to 238.4 + weeks ; 20.5 % censored ) and , for paclitaxel , 53.0 weeks ( range < 1 to 226.3 + weeks ; 12.3 % censored ) ; P = 0.44 . CONCLUSION Topotecan continues to demonstrate comparable efficacy and survival to paclitaxel with manageable and non-cumulative haematological toxicity . Non-haematological toxicity was generally mild for both groups . The long-term survival rate indicates substantial therapeutic benefit for this group of patients receiving topotecan at relapse of ovarian cancer BACKGROUND CALYPSO ( CAeLYx in Platinum Sensitive Ovarian ) patients compared carboplatin-pegylated liposomal doxorubicin ( C-PLD ) with carboplatin-paclitaxel ( C-P ) in patients with late-relapsing recurrent ovarian cancer ( ROC ) . We analyzed outcomes in patients ≥70 years . PATIENTS AND METHODS Nine hundred and seventy-six patients with taxane-pretreated ROC relapsing > 6 months after first- or second-line platinum-based therapy were r and omly assigned to 4-weekly C area under the curve ( AUC ) 5 plus PLD 30 mg/m(2 ) or 3-weekly C AUC 5 plus P 175 mg/m(2 ) for six or more cycles . RESULTS One hundred and fifty-seven ( 16 % ) patients ≥70 years ( median : 74 years , C-PLD ; 73 years , C-P ; range 70 - 82 years ) were included ( n = 71 , C-PLD ; n = 86 , C-P ) . In comparing elderly and younger , elderly patients experienced fewer grade ≥2 allergic reactions ( P = 0.005 ) but more grade ≥2 sensory neuropathy ( P = 0.007 ) . Myelosuppression did not differ with age . Elderly patients completed planned treatment as frequently as younger ( 79 % , C-PLD ; 82 % , C-P ) . In comparing arms within elderly patients , C-P was associated with more grade ≥2 alopecia , sensory neuropathy , arthralgia/myalgia ( P < 0.001 for all ) , severe leukopenia plus febrile neutropenia ; C-PLD was associated with more grade ≥2 h and -foot syndrome ( P = 0.005 ) . Median progression-free survival was 11.6 months ( C-PLD ) and 10.3 months ( C-P ; P = 0.44 ) . CONCLUSIONS Patients ≥70 years experienced more neuropathy , with a higher incidence in the C-P arm . Similar to all study patients , C-PLD provided a better therapeutic index with less toxicity than C-P in elderly women with platinum-sensitive ROC PURPOSE This r and omized , multicenter , phase III noninferiority trial was design ed to test the efficacy and safety of the combination of pegylated liposomal doxorubicin ( PLD ) with carboplatin ( CD ) compared with st and ard carboplatin and paclitaxel ( CP ) in patients with platinum-sensitive relapsed/recurrent ovarian cancer ( ROC ) . PATIENTS AND METHODS Patients with histologically proven ovarian cancer with recurrence more than 6 months after first- or second-line platinum and taxane-based therapies were r and omly assigned by stratified blocks to CD ( carboplatin area under the curve [ AUC ] 5 plus PLD 30 mg/m(2 ) ) every 4 weeks or CP ( carboplatin AUC 5 plus paclitaxel 175 mg/m(2 ) ) every 3 weeks for at least 6 cycles . Primary end point was progression-free survival ( PFS ) ; secondary end points were toxicity , quality of life , and overall survival . RESULTS Overall 976 patients were recruited . With median follow-up of 22 months , PFS for the CD arm was statistically superior to the CP arm ( hazard ratio , 0.821 ; 95 % CI , 0.72 to 0.94 ; P = .005 ) ; median PFS was 11.3 versus 9.4 months , respectively . Although overall survival data are immature for final analysis , we report here a total of 334 deaths . Overall severe nonhematologic toxicity ( 36.8 % v 28.4 % ; P < .01 ) leading to early discontinuation ( 15 % v 6 % ; P < .001 ) occurred more frequently in the CP arm . More frequent grade 2 or greater alopecia ( 83.6 % v 7 % ) , hypersensitivity reactions ( 18.8 % v 5.6 % ) , and sensory neuropathy ( 26.9 % v 4.9 % ) were observed in the CP arm ; more h and -foot syndrome ( grade 2 to 3 , 12.0 % v 2.2 % ) , nausea ( 35.2 % v 24.2 % ) , and mucositis ( grade 2 - 3 , 13.9 % v 7 % ) in the CD arm . CONCLUSION To our knowledge , this trial is the largest in recurrent ovarian cancer and has demonstrated superiority in PFS and better therapeutic index of CD over st and ard CP BACKGROUND To perform a subset analysis of patients with partially platinum-sensitive recurrent ovarian cancer ( ROC ) who received either CD [ carboplatin-pegylated liposomal doxorubicin ( PLD ) ] or CP ( carboplatin-paclitaxel )  in the CALYPSO trial . PATIENTS AND METHODS CALYPSO , an international phase III , non-inferiority trial , enrolled women with ROC that relapsed > 6 months following first- or second-line therapy . Patients were r and omized to CD or CP . Patients with a treatment-free interval of > 6 and ≤ 12 months were evaluated for progression-free survival ( PFS ) , the primary end point of CALYPSO trial , and safety . RESULTS A total of 344 partially platinum-sensitive patients were included ( N = 161 , CD and N = 183 , CP ) . The hazard ratio for PFS was 0.73 ( 95 % confidence interval : 0.58 - 0.90 ; P = 0.004 for superiority ) in favor of CD . Median PFS times were 9.4 months ( CD ) and 8.8 months ( CP ) 
    Output:
    
In people with platinum-sensitive disease , NMA found statistically significant benefits for PLDH plus platinum , and paclitaxel plus platinum  for overall survival ( OS ) compared with platinum monotherapy .
PLDH plus platinum significantly prolonged progression-free survival ( PFS ) compared with paclitaxel plus platinum .
Of the non-platinum-based treatments , PLDH monotherapy and trabectedin plus PLDH were found to significantly increase OS , but not PFS , compared with topotecan monotherapy .
In people with platinum-resistant/-refractory ( PRR ) disease , NMA found no statistically significant differences for any treatment compared with alternative regimens in OS and PFS .
LIMITATIONS As platinum- and non-platinum-based treatments were evaluated separately , the comparative clinical effectiveness and cost-effectiveness of these regimens is uncertain in patients with platinum-sensitive disease .
CONCLUSIONS For platinum-sensitive disease , it was not possible to compare the clinical effectiveness and cost-effectiveness of platinum-based therapies with non-platinum-based therapies .
For people with platinum-sensitive disease and treated with non-platinum-based therapies , it is unclear whether PLDH would be considered cost-effective compared with paclitaxel at a threshold of £ 30,000 per additional QALY ; trabectedin plus PLDH is unlikely to be considered cost-effective compared with PLDH .
For patients with PRR disease , it is unlikely that topotecan would be considered cost-effective compared with PLDH .