At what cost does a potential survival advantage of bevacizumab make sense for the primary treatment of ovarian cancer? A cost-effectiveness analysis Full Text
Journal of Clinical Oncology, 03/11/2011
Clinical Article
Cohn DE et al. – The addition of bevacizumab to standard chemotherapy in patients with advanced ovarian cancer is not cost effective. Treatment with maintenance bevacizumab leads to improved PFS but is associated with both direct and indirect costs. The cost effectiveness of bevacizumab in the adjuvant treatment of ovarian cancer is primarily dependent on drug costs.
Methods- Cost-effectiveness analysis compared 3 arms of Gynecologic Oncology Group (GOG) 218 study (paclitaxel plus carboplatin [PC], PC plus bevacizumab [PCB], and PCB plus bevacizumab maintenance [PCB+B])
- Actual and estimated costs of treatment plus potential costs of complications established for each strategy
- PFS and bowel perforation rates taken from recently reported results of GOG 218
- Sensitivity analysis performed for pertinent uncertainties in model
- Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) estimated
- For 600 patients entered onto each arm of GOG 218 at baseline estimates of PFS and bowel perforation, cost of PC $2.5 million, compared with $21.4 million for PCB and $78.3 million for PCB+B
- Costs led to an ICER of $479,712 per PF-LYS for PCB and $401,088 per PF-LYS for PCB+B
- When cost of bevacizumab reduced to 25% of baseline, ICER of PCB+B fell below $100,000 per PF-LYS
- ICERs not substantially reduced when perforation rate equal across all arms
