title: Real-world and trial-based cost-effectiveness analysis of bevacizumab in HER2-negative metastatic breast cancer patients: a study of the Southeast Netherlands Breast Cancer Consortium.
abstract: The aim of our analysis was to assess the real-world cost-effectiveness of bevacizumab in addition to taxane treatment versus taxane monotherapy for HER2-negative metastatic breast cancer compared with the cost-effectiveness based on the efficacy results from a trial.
  
  
  
  A state transition model was built to estimate costs, life years (LYs) and quality-adjusted life years (QALYs) for both treatments. Two scenarios were examined: a real-world scenario and a trial-based scenario in which transition probabilities were primarily based on a real-world cohort study and the E2100 trial, respectively. In both scenarios, costs and utility parameter estimates were extracted from the real-world cohort study. Moreover, the Dutch health care perspective was adopted.
  
  
  
  In both the real-world and trial scenarios, bevacizumab-taxane is more expensive (incremental costs of €56,213 and €52,750, respectively) and more effective (incremental QALYs of 0.362 and 0.189, respectively) than taxane monotherapy. In the real-world scenario, bevacizumab-taxane compared to taxane monotherapy led to an incremental cost-effectiveness ratio (ICER) of €155,261 per QALY gained. In the trial scenario, the ICER amounted to €278,711 per QALY gained.
  
  
  
  According to the Dutch informal threshold, bevacizumab in addition to taxane treatment was not considered cost-effective for HER2-negative metastatic breast cancer both in a real-world and in a trial scenario.
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: R J W
authors.initials: RJW
authors.lastname: van Kampen
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: B L T
authors.initials: BLT
authors.lastname: Ramaekers
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Máxima Medical Center, Eindhoven, P.O. Box 7777, 5500 MB Eindhoven, The Netherlands.
authors.forename: D J A
authors.initials: DJA
authors.lastname: Lobbezoo
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Máxima Medical Center, Eindhoven, P.O. Box 7777, 5500 MB Eindhoven, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Dercksen
authors.affiliation: Zuyderland Medical Center, Heerlen, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van den Berkmortel
authors.affiliation: Jeroen Bosch Hospital, 's-Hertogenbosch, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands.
authors.forename: T J
authors.initials: TJ
authors.lastname: Smilde
authors.affiliation: VieCuri Medical Center, Venlo, P.O. Box 1926, 5900 BX Venlo, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: van de Wouw
authors.affiliation: Zuyderland Medical Center, Sittard-Geleen, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands.
authors.forename: F P J
authors.initials: FPJ
authors.lastname: Peters
authors.affiliation: St Elisabeth Hospital, Tilburg, P.O. Box 90151, 5000 LC Tilburg, The Netherlands.
authors.forename: J M G
authors.initials: JMG
authors.lastname: van Riel
authors.affiliation: St Jans Hospital, Weert, Vogelsbleek 5, 6001 BE Weert, The Netherlands.
authors.forename: N A J B
authors.initials: NAJB
authors.lastname: Peters
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: V C G
authors.initials: VCG
authors.lastname: Tjan-Heijnen
authors.affiliation: Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: m.joore@mumc.nl.
authors.forename: M A
authors.initials: MA
authors.lastname: Joore
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics; D001952:Bridged-Ring Compounds / Q000191:economics; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D000077143:Docetaxel; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D009426:Netherlands; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics
chemical_list: D000068258:Bevacizumab; D001952:Bridged-Ring Compounds; D000077143:Docetaxel; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; C080625:taxane; C508053:ERBB2 protein, human
keywords: Bevacizumab; Cost-benefit analysis; Cost-effectiveness analysis; Metastatic breast cancer; Real-world; Trial based