title: Is FDA-Approved Bevacizumab Cost-Effective When Included in the Treatment of Platinum-Resistant Recurrent Ovarian Cancer?
abstract: Although the Food and Drug Administration has approved incorporation of bevacizumab (BEV) into the treatment of platinum-resistant ovarian cancer (PROC), cost-value measures are an essential consideration, as evidenced by the recent ASCO Value Framework initiative. We assessed the cost-effectiveness and reviewed the net health benefit (NHB) of this expensive treatment.
  
  
  
  A cost-effectiveness decision model was constructed using results from a phase III trial comparing BEV plus cytotoxic chemotherapy with chemotherapy alone in patients with PROC. The Avastin Use in Platinum-Resistant Epithelial Ovarian Cancer (AURELIA) trial demonstrated improvement in progression-free survival and quality of life in patients receiving BEV. Costs, paracentesis rates, and adverse events were incorporated, including subgroup analysis of different partner chemotherapy agents.
  
  
  
  Inclusion of BEV in the treatment of platinum-resistant recurrent ovarian cancer meets the common willingness-to-pay incremental cost-effectiveness ratio (ICER) threshold of $100,000 per progression-free life-year saved (LYS) for 15-mg/kg dosing and approaches this threshold for 10-mg/kg dosing, with an ICER of $160,000. In sensitivity analysis, reducing the cost of BEV by 13% (from $9,338 to $8,100 per cycle) allows 10-mg/kg dosing to reach a $100,000 ICER. Exploratory analysis of different BEV chemotherapy partners showed an ICER of $76,000 per progression-free LYS (6.5-month progression-free survival improvement) and $54,000 per LYS (9.1-month overall survival improvement) for the addition of BEV to paclitaxel once per week. Using the ASCO framework for value assessment, the NHB score for BEV plus paclitaxel once per week is 48.
  
  
  
  Using a willingness-to-pay threshold of $100,000 ICER, the addition of BEV to chemotherapy either demonstrates or approaches cost-effectiveness and NHB when added to the treatment of patients with PROC.
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX nicpchappell@gmail.com.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Chappell
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Caela R
authors.initials: CR
authors.lastname: Miller
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Fielden
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017277:Drug Approval; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000191:economics*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000191:economics*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D020533:Angiogenesis Inhibitors; D009944:Organoplatinum Compounds; D000068258:Bevacizumab