title: Bevacizumab in recurrent, persistent, or advanced stage carcinoma of the cervix: is it cost-effective?
abstract: OBJECTIVE
  Evaluate the cost-effectiveness of incorporating bevacizumab into the treatment regimen for recurrent, persistent, or advanced stage carcinoma of the cervix following publication of a recent phase III trial that demonstrated an overall survival (OS) benefit with the addition of bevacizumab.
  
  
  METHODS
  A cost-effectiveness decision model was constructed using recently published results from a Gynecologic Oncology Group phase III study, comparing a standard chemotherapy regimen (Chemo) to the experimental regimen (Chemo + Bev) consisting of the standard regimen+bevacizumab. Costs and adverse events were incorporated and sensitivity analyses assessed model uncertainties.
  
  
  RESULTS
  The cost of Chemo + Bev was $53,784 compared to $5,688 for the Chemo arm. The 3.7 month OS advantage with Chemo+Bev came at an incremental cost-effectiveness ratio (ICER) of $155K per quality-adjusted life year (QALY). Chemo + Bev becomes cost-effective with an ICER ≤ $100K in sensitivity analysis when the cost of bevacizumab is discounted >37.5% or the dose is reduced from 15 to 7.5 mg/kg, an effective dose in ovarian cancer.
  
  
  CONCLUSIONS
  With an ICER of $155K/QALY, the addition of bevacizumab to standard chemotherapy approaches common cost-effectiveness standards. Moderately discounting the cost of bevacizumab or using a smaller dose significantly alters its affordability.
authors.affiliation: Gynecologic Oncology Service, Walter Reed National Military Medical Center, Room 3440, 3rd floor, Gyn Bldg 19, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. Electronic address: neil.phippen@icloud.com.
authors.forename: Neil T
authors.initials: NT
authors.lastname: Phippen
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Room 10250, 1700 6th Avenue South, Birmingham, AL 35233, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
authors.affiliation: Division of Gynecologic Oncology, Duke Cancer Center, 20 Duke Medicine Circle, Durham, NC 27710, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.affiliation: Division of Gynecologic Oncology, Department of OB/GYN, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam, Houston, TX 78234, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000068258:Bevacizumab; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D018803:Models, Economic; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D019772:Topotecan / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000191:economics*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D019772:Topotecan; D017239:Paclitaxel; D002945:Cisplatin
keywords: Bevacizumab; Cervical cancer; Cost-effectiveness