abstract
Background
Bevacizumab
is used extensively in the treatment of cancer, including advanced
ovarian cancer, for which results of the International Collaborative
Ovarian Neoplasm (ICON) 7 trial have been recently reported. The
National Institute for Health and Care Excellence’s (NICE’s) recent
decision not to recommend bevacizumab for advanced ovarian cancer was
not based on evidence related to the unlicensed lower dosage (7.5 mg/kg)
of the drug despite its use in the English National Health Service
(NHS) and the ICON7 trial.
Objective
To report on the findings of an analysis that considered whether the
lower dose is cost-effective.
Methods
Cost-effectiveness
analysis is assessed from the perspective of the English NHS and health
outcomes expressed in terms of quality-adjusted life-years (QALYs). The
analysis focuses on a clinically predefined high-risk subgroup of the
ICON7 trial. The price at which the lower dose of bevacizumab could be
considered cost-effective for the English NHS is presented for a range
of scenarios to inform decisions about
price negotiations by
international health systems.
Results
In
the base-case analysis, bevacizumab has an incremental
cost-effectiveness ratio of £48,975 per additional QALY, which is above
NICE’s standard cost-effectiveness threshold (£20,000–£30,000 per QALY).
The official price of bevacizumab in 2013 was between £2.31 and £2.63
per milligram. A price reduction of between 46% and 67%, dependent on
the NICE threshold, would be required for the product to be
cost-effective in the high-risk subgroup.
Conclusions
The
lower dose of bevacizumab for advanced ovarian cancer is not
cost-effective based on the product’s list price and using NICE’s
cost-effectiveness thresholds.
Significant price discounts would be
needed to make the drug affordable to the NHS.
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