Bevacizumab
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX.
INTRODUCTION:
The
recent FDA approval of inclusion of bevacizumab (BEV) in the treatment
of platinum-resistant recurrent ovarian cancer will likely lead to more
widespread adoption of this intervention. We assessed the cost
effectiveness of this expensive treatment for this specific indication.
METHODS:
A
cost effectiveness decision model was constructed using results from
AURELIA, a phase III randomized trial comparing BEV plus cytotoxic
chemotherapy versus chemotherapy alone in patients with
platinum-resistant recurrent ovarian cancer. The BEV arm of AURELIA had
improved progression free survival and quality of life (QOL). Costs,
paracentesis rates, and adverse events were incorporated.
RESULTS:
Inclusion
of BEV in the treatment of platinum-resistant recurrent ovarian cancer
costs on average $26,790 more than cytotoxic chemotherapy alone when 15
mg/kg dosing is used and $40,813 more when biweekly 10 mg/kg is used.
The incremental cost-effectiveness ratio (ICER) per progression-free
life year saved (PF-LYS) is $146K with 10 mg/kg dosing and $96K with 15
mg/kg dosing. In sensitivity analysis, the ICER drops below a
willingness-to-pay (WTP) threshold of $100K when greater than 68% of
patients receive salvage single agent BEV. Incorporating better QOL in
the BEV arm based on AURELIA improves the ICER in both dosing regimens,
but does not lower the ICER below $100K at the 10 mg/kg dose.
CONCLUSION/IMPLICATIONS:
Our
results suggest that incorporation of BEV using the 15 mg/kg regimen is
cost-effective based on the common WTP threshold ICER of $100K. In
light of FDA approval for this indication, evidence for
cost-effectiveness further supports utilization in women with
platinum-resistant recurrent ovarian cancer.
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