The cost effectiveness of bevacizumab when added to capecitabine, with or without mitomycin-C, in first line treatment of metastatic colorectal cancer: results from the Australasian phase III MAX study.
BACKGROUND
Based on the clinical data, bevacizumab has been approved in Australia and globally for the treatment of advanced colorectal cancer. However, limited evidence exists for its cost-effectiveness. The purpose of this study was to evaluate the cost effectiveness of adding bevacizumab to capecitabine monotherapy in patients with metastatic colorectal cancer, using data from the prospective economic evaluation conducted alongside the MAX trial.


METHODS
Individual patient level data on resource use and progression free survival were prospectively collected in the phase III MAX trial. Resource use data were collected for the period between randomisation and disease progression, and unit costs were assigned from the perspective of the Australian health care funder. Effectiveness was measured in quality adjusted progression free survival years, with utility scores obtained from both the community valued EQ-5D questionnaire and the patient valued UBQ-C questionnaire. Progression free survival was used as a secondary effectiveness measure.


RESULTS
The addition of bevacizumab to capecitabine monotherapy cost approximately $192,156 (95% confidence interval [CI], $135,619 to $326,894) per quality adjusted progression free survival year gained when using publicly listed pharmaceutical prices and utility values from the EQ-5D questionnaire. This decreased to $149,455 (95% CI, $100,356 to $245,910) when values from the UBQ-C questionnaire were applied. The incremental cost per progression free survival year was $145,059 (95% CI, $106,703 to $233,225).


CONCLUSIONS
Bevacizumab was not found to be cost effective at its listed price, based on results from the MAX trial.
NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 2050, Australia. Electronic address: hannah.carter@ctc.usyd.edu.au.
Hannah E
HE
Carter
NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 2050, Australia.
Diana
D
Zannino
NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 2050, Australia.
R
R
John Simes
NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 2050, Australia.
Deborah J
DJ
Schofield
School of Public Health, The University of Sydney, Edward Ford Building, NSW 2006, Australia.
Kirsten
K
Howard
Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, VIC 8006, Australia; Department of Oncology, University of Melbourne, Australia.
John R
JR
Zalcberg
The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville, SA 5011, Australia; The University of Adelaide, Australia.
Timothy J
TJ
Price
Austin Health, PO Box 5555, Heidelberg, VIC 3084, Australia.
Niall C
NC
Tebbutt
D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001315:Australia; D000068258:Bevacizumab; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D016685:Mitomycin / Q000191:economics*; D011788:Quality of Life; D016896:Treatment Outcome
D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000068258:Bevacizumab; D016685:Mitomycin; D000069287:Capecitabine; D005472:Fluorouracil
Bevacizumab; Cancer; Colorectal; Cost; Effectiveness; MAX