title: Survival and lifetime costs associated with first-line bevacizumab use in older patients with metastatic colorectal cancer.
abstract: BACKGROUND
  The objective of this study was to investigate clinical effectiveness and incremental lifetime costs associated with first-line bevacizumab in older patients with metastatic colorectal cancer (mCRC).
  
  
  METHODS
  Patients diagnosed with mCRC in 2004-2007 were identified from the Surveillance, Epidemiology, and End Results-Medicare database and stratified by first-line treatment (no chemotherapy [CTx], CTx alone, CTx plus bevacizumab). The impact of first-line bevacizumab on survival was investigated using a propensity score adjusted multivariate Cox proportional hazards model. Mean lifetime costs for each cohort were calculated using Medicare claims for all services rendered between diagnosis and end of follow-up, adjusting for death and censoring.
  
  
  RESULTS
  A total of 4,414 patients (mean age: 77.3 years) were identified, of whom 15% received first-line bevacizumab. Among first-line-treated patients, bevacizumab receipt was associated with improved overall survival (hazard ratio: 0.85 [95% confidence interval: 0.75-0.97]; p = .013), and this benefit was limited to patients who received >1 month of bevacizumab therapy. Median and mean survival were greatest in patients treated with CTx plus bevacizumab relative to CTx alone (CTx plus bevacizumab median 19.4 months [mean 28.0 months] vs. CTx alone median 15.1 months [mean 22.9 months]; p < .001), as were mean lifetime costs (mean per patient cost $143,284 vs. $111,280). Compared with CTx alone, CTx plus bevacizumab was associated with a 5.1-month increase in mean survival and a $32,004 increase in mean lifetime treatment costs, with an incremental cost of $75,303 per life-year gained.
  
  
  CONCLUSIONS
  Bevacizumab use is associated with longer survival than CTx alone in older patients treated in real-world clinical settings, at an incremental cost of $75,303 per life-year gained.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA vshank@uw.edu.
authors.forename: Veena
authors.initials: V
authors.lastname: Shankaran
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Mummy
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Lisel
authors.initials: L
authors.lastname: Koepl
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Aasthaa
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Mirick
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Yu
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Morlock
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Sarika
authors.initials: S
authors.lastname: Ogale
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; School of Medicine and Pharmaceutical Outcomes, Research, and Policy Program School of Pharmacy, University of Washington, Seattle, Washington, USA; Genentech, Inc., South San Francisco, California, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: Bevacizumab; Clinical effectiveness; Elderly; Lifetime costs; Metastatic colorectal cancer
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