title: A Markov model to evaluate cost-effectiveness of antiangiogenesis therapy using bevacizumab in advanced cervical cancer.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of bevacizumab in recurrent/persistent and metastatic cervical cancer using recently reported updated survival and toxicology data.
  
  
  METHODS
  A Markov decision tree based on the Gynecologic Oncology Group 240 randomized trial was created. The 2013 MediCare Services Drug Payment Table and Physician Fee Schedule provided costs. In the 5-year model subjects transitioned through the following states: response, progression, minor complications, severe complications, and death. Patients experiencing a health utility per month according to treatment effectiveness were calculated. Because cervical cancer survival is measured in months rather than years, results were reported in both quality adjusted cervical cancer life months and years (QALmonth, QALY), adjusted from a baseline of having advanced cervical cancer during a month.
  
  
  RESULTS
  The estimated total cost of therapy with bevacizumab is approximately 13.2 times that for chemotherapy alone, adding $73,791 per 3.5months (0.29year) of life gained, resulting in an incremental cost-effectiveness ratio (ICER) of $21.083 per month of added life. The ICER increased to $5775 per month of added life and $24,597/QALmonth ($295,164/QALY) due to the smaller difference in QALmonths. With 75% bevacizumab cost reduction, the ICER is $6737/QALmonth ($80,844/QALY), which translates to $23,580 for the 3.5month (0.29year) gain in OS.
  
  
  CONCLUSIONS
  Increased costs are primarily related to the cost of drug and not the management of bevacizumab-induced complications. Cost reductions in bevacizumab result in dramatic declines in the ICER, suggesting that cost reconciliation in advanced cervical cancer may be possible through the availability of biosimilars, and/or less expensive, equally efficacious anti-angiogenesis agents.
authors.affiliation: University of Arizona Cancer, Center and Creighton University at St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Minion
authors.affiliation: The Paul Merage School of Business, University of California, Irvine, Irvine, CA 92697, USA.
authors.forename: Jiaru
authors.initials: J
authors.lastname: Bai
authors.affiliation: University of Arizona Cancer, Center and Creighton University at St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.affiliation: The Paul Merage School of Business, University of California, Irvine, Irvine, CA 92697, USA.
authors.forename: L
authors.initials: L
authors.lastname: Robin Keller
authors.affiliation: The Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
authors.forename: Eskander N
authors.initials: EN
authors.lastname: Ramez
authors.affiliation: The Paul Merage School of Business, University of California, Irvine, Irvine, CA 92697, USA; The Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
authors.forename: Gareth K
authors.initials: GK
authors.lastname: Forde
authors.affiliation: California Pacific Palo Alto Medical Foundation, Sutter Cancer Institute, San Francisco, CA 94118, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Chan
authors.affiliation: The Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA 92868, USA. Electronic address: ktewari@uci.edu.
authors.forename: Krishnansu S
authors.initials: KS
authors.lastname: Tewari
mesh_terms: 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 / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab; D059451:Biosimilar Pharmaceuticals / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D005260:Female; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000473:pathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D059451:Biosimilar Pharmaceuticals; D000068258:Bevacizumab
keywords: Antiangiogenesis therapy; Bevacizumab; Cervical cancer; Cost-effectiveness; Markov model