Bevacizumab in treatment of high-risk ovarian cancer--a cost-effectiveness analysis.
The objective of this study was to evaluate a cost-effectiveness strategy of bevacizumab in a subset of high-risk advanced ovarian cancer patients with survival benefit. Methods. A subset analysis of the International Collaboration on Ovarian Neoplasms 7 trial showed that additions of bevacizumab (B) and maintenance bevacizumab (mB) to paclitaxel (P) and carboplatin (C) improved the overall survival (OS) of high-risk advanced cancer patients. Actual and estimated costs of treatment were determined from Medicare payment. Incremental cost-effectiveness ratio per life-year saved was established. Results. The estimated cost of PC is $535 per cycle; PCB + mB (7.5 mg/kg) is $3,760 per cycle for the first 6 cycles and then $3,225 per cycle for 12 mB cycles. Of 465 high-risk stage IIIC (>1 cm residual) or stage IV patients, the previously reported OS after PC was 28.8 months versus 36.6 months in those who underwent PCB + mB. With an estimated 8-month improvement in OS, the incremental cost-effectiveness ratio of B was $167,771 per life-year saved. Conclusion. In this clinically relevant subset of women with high-risk advanced ovarian cancer with overall survival benefit after bevacizumab, our economic model suggests that the incremental cost of bevacizumab was approximately $170,000.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA; Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA; Columbia University School of Medicine, New York, New York, USA; California Pacific Medical Center Research Institute, San Francisco, California, USA; Division of Gynecologic Oncology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
John K
JK
Chan
Thomas J
TJ
Herzog
Lilian
L
Hu
Bradley J
BJ
Monk
Tuyen
T
Kiet
Kevin
K
Blansit
Daniel S
DS
Kapp
Xinhua
X
Yu
D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D016190:Carboplatin / Q000191:economics / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D017239:Paclitaxel / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D016190:Carboplatin; D017239:Paclitaxel
Bevacizumab; Cost-effectiveness analysis; Markov chain; Ovarian cancer