title: Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer.
abstract: Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment.
  
  
  
  Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters.
  
  
  
  CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated.
  
  
  
  CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.
authors.affiliation: University Medical Center Utrecht, Department of Medical Oncology, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Franken
authors.affiliation: Institute for Medical Technology Assessment/Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: van Rooijen
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: May
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Koffijberg
authors.affiliation: The Netherlands Cancer Institute, Department of Biostatistics, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
authors.affiliation: Netherlands Comprehensive Cancer Organization, P.O. Box 1281, 6501 BG Nijmegen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Mol
authors.affiliation: Amphia Hospital, Department of Medical Oncology, P.O. Box 90158, 4800 RK Breda, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Ten Tije
authors.affiliation: Catharina Hospital, Department of Medical Oncology, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Creemers
authors.affiliation: Tergooi Hospital, Department of Medical Oncology, P.O. Box 10016, 1201 DA Hilversum, The Netherlands.
authors.forename: A M T
authors.initials: AMT
authors.lastname: van der Velden
authors.affiliation: Groene Hart Hospital, Department of Medical Oncology, P.O. Box 1098, 2800 BB Gouda, The Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Tanis
authors.affiliation: Institute for Medical Technology Assessment/Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.affiliation: Academic Medical Center, Department of Medical Oncology, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: C J A
authors.initials: CJA
authors.lastname: Punt
authors.affiliation: University Medical Center Utrecht, Department of Medical Oncology, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koopman
authors.affiliation: Academic Medical Center, Department of Medical Oncology, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.g.vanoijen@amc.uva.nl.
authors.forename: M G H
authors.initials: MGH
authors.lastname: van Oijen
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000191:economics* / Q000627:therapeutic use; D000069287:Capecitabine / Q000191:economics* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D009426:Netherlands; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D000970:Antineoplastic Agents; D000068258:Bevacizumab; D000069287:Capecitabine
keywords: Bevacizumab; Cancer; Capecitabine; Colorectal; Cost-effectiveness