The Cost-Effectiveness of Bevacizumab in Advanced Ovarian Cancer Using Evidence from the ICON7 Trial.
BACKGROUND
Bevacizumab is used extensively in the treatment of cancer, including advanced ovarian cancer, for which results of the International Collaborative Ovarian Neoplasm (ICON) 7 trial have been recently reported. The National Institute for Health and Care Excellence's (NICE's) recent decision not to recommend bevacizumab for advanced ovarian cancer was not based on evidence related to the unlicensed lower dosage (7.5 mg/kg) of the drug despite its use in the English National Health Service (NHS) and the ICON7 trial.


OBJECTIVE
To report on the findings of an analysis that considered whether the lower dose is cost-effective.


METHODS
Cost-effectiveness analysis is assessed from the perspective of the English NHS and health outcomes expressed in terms of quality-adjusted life-years (QALYs). The analysis focuses on a clinically predefined high-risk subgroup of the ICON7 trial. The price at which the lower dose of bevacizumab could be considered cost-effective for the English NHS is presented for a range of scenarios to inform decisions about price negotiations by international health systems.


RESULTS
In the base-case analysis, bevacizumab has an incremental cost-effectiveness ratio of £48,975 per additional QALY, which is above NICE's standard cost-effectiveness threshold (£20,000-£30,000 per QALY). The official price of bevacizumab in 2013 was between £2.31 and £2.63 per milligram. A price reduction of between 46% and 67%, dependent on the NICE threshold, would be required for the product to be cost-effective in the high-risk subgroup.


CONCLUSIONS
The lower dose of bevacizumab for advanced ovarian cancer is not cost-effective based on the product's list price and using NICE's cost-effectiveness thresholds. Significant price discounts would be needed to make the drug affordable to the NHS.
Centre for Health Economics, University of York, York, UK. Electronic address: Sebastian.hinde@york.ac.uk.
Sebastian
S
Hinde
Centre for Health Economics, University of York, York, UK; Department of Applied Economics, University of Granada, Granada, Spain.
David
D
Epstein
Medical Research Council Clinical Trials Unit, University College London, London, UK.
Adrian
A
Cook
Medical Research Council Clinical Trials Unit, University College London, London, UK.
Andrew
A
Embleton
St James Institute of Oncology, St James University Hospital, Leeds, UK.
Timothy
T
Perren
Centre for Health Economics, University of York, York, UK.
Mark
M
Sculpher
D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000494:pharmacology; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000191:economics* / Q000494:pharmacology; D016190:Carboplatin / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017239:Paclitaxel / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D016019:Survival Analysis
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D000068258:Bevacizumab; D016190:Carboplatin; D017239:Paclitaxel
bevacizumab; cost-effectiveness; economic evaluation; ovarian cancer