Bevacizumab Continuation Versus Treatment Holidays After First-Line Chemotherapy With Bevacizumab in Patients With Metastatic Colorectal Cancer: A Health Economic Analysis of a Randomized Phase 3 Trial (SAKK 41/06).
Bevacizumab (BEV)-containing therapies are costly. We performed a health economic analysis of a randomized phase 3 study (SAKK 41/06) that compared BEV continuation as a single agent (BEV) with treatment holidays (no BEV) after completing 4 to 6 cycles of first-line chemotherapy plus BEV in metastatic colorectal cancer patients.



Costs for first-line chemotherapy with BEV, BEV continuation therapy, hospitalizations (length of stay), control visits, diagnostic tests, and second-line and later rounds of chemotherapy were collected. Mean costs per patient per treatment arm and an incremental cost-effectiveness ratio were calculated. Probabilistic sensitivity analysis was performed to account for uncertainty in the input parameters.



The total incurred mean costs per patient were 126,631 Swiss francs (CHF) [95% confidence interval (CI), 116,521-136,740] for BEV versus CHF100,146 (95% CI, 92,811-107,481) for no BEV. The incremental cost effectiveness ratio was CHF108,991 per life-year gained (LYG; 95% CI from probabilistic sensitivity analysis, 62,890-248,515). Compared to a willingness-to-pay threshold of CHF100,000/LYG, there was 42% probability that BEV continuation was cost effective, which decreased to 20% at a threshold of CHF75,000/LYG. Economic equality was reached in only 0.07% of cases.



The clinical conclusion that BEV continuation as a single agent after completion of first-line chemotherapy is of low therapeutic value is supported by this health economic analysis. Costs increase without significant clinical benefit in this setting.
Institute of Pharmaceutical Medicine/ECPM, University Basel, Basel, Switzerland. Electronic address: klazien.matter@unibas.ch.
Klazien
K
Matter-Walstra
Institute of Pharmaceutical Medicine/ECPM, University Basel, Basel, Switzerland.
Matthias
M
Schwenkglenks
Hôpital Fribourgeois, Oncology, Fribourg, Switzerland.
Daniel
D
Betticher
Kantonsspital Graubünden, Oncology, Chur, Switzerland.
Roger
R
von Moos
SAKK Coordinating Centre, Bern, Switzerland.
Daniel
D
Dietrich
SAKK Coordinating Centre, Bern, Switzerland.
Daniela
D
Baertschi
Kantonsspital St Gallen, now at St Claraspital, Oncology, Basel, Switzerland.
Dieter
D
Koeberle
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000191:economics*; D000068258:Bevacizumab / Q000008:administration & dosage* / Q000191:economics*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013557:Switzerland
D000068258:Bevacizumab
Bevacizumab; Colorectal cancer; Costs; Incremental cost effectiveness; Randomized controlled trial