title: Adding bevacizumab to single agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer: A cost effectiveness analysis of the AURELIA trial.
abstract: AURELIA, a randomized phase III trial of adding bevacizumab (B) to single agent chemotherapy (CT) for the treatment of platinum-resistant recurrent ovarian cancer, demonstrated improved progression free survival (PFS) in the B+CT arm compared to CT alone. We aimed to evaluate the cost effectiveness of adding B to CT in the treatment of platinum-resistant recurrent ovarian cancer.
  
  
  
  A decision tree model was constructed to evaluate the cost effectiveness of adding bevacizumab (B) to single agent chemotherapy (CT) based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and progression free survival (PFS) were modeled over fifteen months. Model inputs were extracted from published literature and public sources. Incremental cost effectiveness ratios (ICERs) per QALY gained and ICERs per progression free life year saved (PF-LYS) were calculated. One-way sensitivity analyses were performed to evaluate the robustness of results.
  
  
  
  The ICER associated with B+CT is $410,455 per QALY gained and $217,080 per PF-LYS. At a willingness to pay (WTP) threshold of $50,000/QALY, adding B to single agent CT is not cost effective for this patient population. Even at a WTP threshold of $100,000/QALY, B+CT is not cost effective. These findings are robust to sensitivity analyses.
  
  
  
  Despite gains in QALY and PFS, the addition of B to single agent CT for treatment of platinum-resistant recurrent ovarian cancer is not cost effective. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this patient population.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States. Electronic address: wwysham@lhs.org.
authors.forename: Weiya Z
authors.initials: WZ
authors.lastname: Wysham
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States.
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Schaffer
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States.
authors.forename: Theresa
authors.initials: T
authors.lastname: Coles
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States.
authors.forename: Dario R
authors.initials: DR
authors.lastname: Roque
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000191:economics; D009944:Organoplatinum Compounds / Q000494:pharmacology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics*
chemical_list: D009944:Organoplatinum Compounds; D000068258:Bevacizumab
keywords: Aurelia; Bevacizumab; Cost-effectiveness