OBJECTIVES: Kaposi sarcoma is an angioproliferative mesenchymal neoplasm caused by Kaposi sarcoma-related herpesvirus (human herpesvirus eight or HHV8). It mainly affects the dermal arteries and shows itself in the skin, mucosa, and viscera. Pegylated-Liposomal Doxorubicin (PLD) and Paclitaxel are among the most common first-line choices for treating Kaposi sarcoma. This study aims to assess the cost-effectiveness of PLD compared to Paclitaxel in treating patients suffering from Kaposi's sarcoma.

METHODS: The analysis was performed Using a 3-state Markov model, from a payer perspective over a 20 years time horizon and a cycle length of two weeks in Iran. The effectiveness was measured as quality-adjusted life years (QALYs) derived from the literature. Drug safety and efficacy were extracted from the NCT00003350 phase III trial. Direct medical costs, including drugs, diagnostic tests, hospitalization, follow-up, and adverse event management, were calculated according to hospital records and national tariffs. Costs and outcomes were discounted at 7.2% and 5%, respectively. Deterministic and probabilistic sensitivity analyses (PSA) were performed To evaluate the robustness of the model.

RESULTS: PLD is associated with a higher average cost of treatment compared to Paclitaxel ($5642 vs. $1949) and greater QALYs gained (4.395 vs. 1.869). The ICER was calculated at $1462 per QALY. PSA showed PLD has a 90% chance of being cost-effective at the willingness to pay threshold of 1GDP/capita in Iran (US$2,422). Furthermore, the deterministic sensitivity analysis showed that the model is most sensitive to the price of PDL, utility discount rate, cost discount rate, cost of monitoring for PLD, and the price of Paclitaxel.

CONCLUSIONS: Treatment with PLD is associated with higher costs and QALYs than Paclitaxel. Since the calculated ICER was below the cost-effectiveness threshold, PLD is a cost-effective option in treating Kaposi sarcoma.