Cost-effectiveness of adding bevacizumab to first line therapy for patients with advanced ovarian cancer.
OBJECTIVE
To evaluate, from a societal perspective, the cost-effectiveness of adding bevacizumab to first-line therapy based on outcomes from the GOG-218 and ICON-7 trials.


METHODS
A three-state Markov model was used. The time horizon was until the death of 99% of the initial cohort of 1000 individuals. Costs and quality-adjusted life-years (QALYs) were discounted at an annual rate of 3%. All costs were adjusted to 2013 USD. The incremental cost-effectiveness ratio (ICER) was reported as incremental cost per QALY gained. The robustness of the result was checked with one-way sensitivity analyses and for relevant clinical situations (i.e. varying the drug of choice to treat cancer recurrence). Subgroup analysis was conducted to identify subgroup of population for whom the strategy could be cost-effective. The potential impact of biosimilar bevacizumab was considered, using a 30% price reduction.


RESULTS
For the GOG-218 study protocol, widely followed in US, the addition of bevacizumab results in an ICER of $2,420,691/QALY. For the ICON-7 study protocol, the ICER is $225,515/QALY. The results of the model were sensitive to the quality of life (QoL) and the median progression free survival (PFS). Biosimilar bevacizumab didn't reduce cost sufficiently to change conclusions. First-line augmentation is cost-effective, with biosimilar bevacizumab, for stage IV patients ($126,169/QALY), ECOG PS1 patients ($116,575/QALY) and for patients with suboptimal residual disease ($122,822/QALY) as per the ICON-7 protocol.


CONCLUSIONS
Addition of bevacizumab, by in large, is cost-ineffective. It can become cost-effective with the ICON-7 protocol, in patients at high risk of progression using biosimilar bevacizumab.
Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, USA.
Darshan A
DA
Mehta
Clinical Pharmacy and Pharmaceutical Economics & Policy, Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, USA. Electronic address: jhay@usc.edu.
Joel W
JW
Hay
D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab; D059451:Biosimilar Pharmaceuticals / Q000008:administration & dosage / Q000191:economics*; D016190:Carboplatin / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D002986:Clinical Trials as Topic / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage
D061067:Antibodies, Monoclonal, Humanized; D059451:Biosimilar Pharmaceuticals; D000068258:Bevacizumab; D016190:Carboplatin; D017239:Paclitaxel
Bevacizumab; Cost-effectiveness; Ovarian cancer; Platinum sensitive; Platinum-resistant; Subgroup