title: Is the routine use of bevacizumab in the treatment of women with advanced or recurrent cancer of the cervix sustainable?
abstract: BACKGROUND
  New chemotherapy combinations are being tested for the treatment of women with advanced, persistent or recurrent cervical cancer. We sought to evaluate the cost effectiveness of some newer combination therapies in cervical cancer.
  
  
  METHODS
  A cost effectiveness decision model was used to analyze Gynecologic Oncology Group 240. All regimens were modeled for seven cycles. The regimens studied are as follows: regimen 1, cisplatin/paclitaxel (CP); regimen 2, CP with bevacizumab (CP+B); regimen 3, paclitaxel/topotecan (PT); and regimen 4, PT with bevacizumab (PT+B). Overall survival, cost, and complications were studied. Sensitivity analyses were performed.
  
  
  RESULTS
  Mean chemotherapy costs over mean total costs for seven cycles of each follows: CP $571/$32,966; CP+B $61,671/$96,842; PT $9,211/$71,620; and PT+B $70,312/$109,211. Incremental cost-effectiveness ratio (ICER) for CP+B was $133,559/quality adjusted life year (QALY). ICER for PT+B was $124,576/QALY. To achieve an incremental ICER for CP+B:CP of <$50,000/QALY gained, the mean overall survival has to increase from 1.1 years with CP to 3.5 years with CP+B. An ICER <$50,000/QALY for the other regimens would take a survival of >10 years for PT and 4.1 years for PT+B. Treating 1,000 women with cervical cancer with CP+B would cost almost double the cost of treating >18,000 women with ovarian cancer annually (carboplatin/paclitaxel).
  
  
  CONCLUSIONS
  CP is the most cost effective regimen. A 12-month increase in overall survival will not even make the newer combinations cost effective. Currently, the use of bevacizumab is not sustainable at today's costs.
authors.affiliation: Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Klag
authors.affiliation: Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Walter
authors.affiliation: Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Sheely
authors.affiliation: Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Manahan
authors.affiliation: Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Geisler
keywords: bevacizumab; cervical cancer; chemotherapy; cost-effectiveness