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Published on: October 27, 2014
Bevacizumab in treatment of high-risk ovarian cancer--a cost-effectiveness analysis
John K Chan1, Thomas J Herzog, Lilian Hu
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA; Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA; Columbia University School of Medicine, New York, New York, USA; California Pacific Medical Center Research Institute, San Francisco, California, USA; Division of Gynecologic Oncology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Abstract:
The objective of this study was to evaluate a cost-effectiveness strategy of bevacizumab in a subset of high-risk advanced ovarian cancer patients with survival benefit. Methods. A subset analysis of the International Collaboration on Ovarian Neoplasms 7 trial showed that additions of bevacizumab (B) and maintenance bevacizumab (mB) to paclitaxel (P) and carboplatin (C) improved the overall survival (OS) of high-risk advanced cancer patients. Actual and estimated costs of treatment were determined from Medicare payment. Incremental cost-effectiveness ratio per life-year saved was established. Results. The estimated cost of PC is $535 per cycle; PCB + mB (7.5 mg/kg) is $3,760 per cycle for the first 6 cycles and then $3,225 per cycle for 12 mB cycles. Of 465 high-risk stage IIIC (>1 cm residual) or stage IV patients, the previously reported OS after PC was 28.8 months versus 36.6 months in those who underwent PCB + mB. With an estimated 8-month improvement in OS, the incremental cost-effectiveness ratio of B was $167,771 per life-year saved. Conclusion. In this clinically relevant subset of women with high-risk advanced ovarian cancer with overall survival benefit after bevacizumab, our economic model suggests that the incremental cost of bevacizumab was approximately $170,000.
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