At What Cost Does a Potential Survival Advantage of Bevacizumab Make Sense for the Primary Treatment of Ovarian Cancer? A Cost-Effectiveness Analysis

The Ohio State University College of Medicine, Columbus, OH, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2011; 29(10):1247-51. DOI: 10.1200/JCO.2010.32.1075
Source: PubMed

ABSTRACT To determine whether the addition of bevacizumab to paclitaxel and carboplatin for the primary treatment of advanced ovarian cancer can be cost effective.
A cost-effectiveness analysis compared the three arms of the Gynecologic Oncology Group (GOG) 218 study (paclitaxel plus carboplatin [PC], PC plus bevacizumab [PCB], and PCB plus bevacizumab maintenance [PCB+B]). Actual and estimated costs of treatment plus the potential costs of complications were established for each strategy. Progression-free survival (PFS) and bowel perforation rates were taken from recently reported results of GOG 218. Sensitivity analysis was performed for pertinent uncertainties in the model. Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) were estimated.
For the 600 patients entered onto each arm of GOG 218 at the baseline estimates of PFS and bowel perforation, the cost of PC was $2.5 million, compared with $21.4 million for PCB and $78.3 million for PCB+B. These costs led to an ICER of $479,712 per PF-LYS for PCB and $401,088 per PF-LYS for PCB+B. When the cost of bevacizumab was reduced to 25% of baseline, the ICER of PCB+B fell below $100,000 per PF-LYS. ICERs were not substantially reduced when the perforation rate was equal across all arms.
The addition of bevacizumab to standard chemotherapy in patients with advanced ovarian cancer is not cost effective. Treatment with maintenance bevacizumab leads to improved PFS but is associated with both direct and indirect costs. The cost effectiveness of bevacizumab in the adjuvant treatment of ovarian cancer is primarily dependent on drug costs.

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    • "No analysis of the cost such a small increase in survival would cause was performed. US healthcare related costs are expected to account for 25% of the gross domestic product by 20147. With current governmental budgetary demands, this level of healthcare expenditure is not sustainable. "
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    • "Arm 3 showed an improvement of 4 months in progression-free survival compared with arm 1, and demonstrated that the addition of bevacizumab showed benefit over conventional chemotherapy. Although the results may be statistically different, their clinical relevance may be tempered by the potential high costs related to bevacizumab therapy.70 In addition, there was no significant difference in overall survival between the three arms, but it should be noted that the study was not powered for overall survival.69 "
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    • "Treatment related toxicity and financial costs represent an important issue for expensive drugs like bevacizumab. Cohn et al. [17] have recently analyzed the cost effectiveness of bevacizumab in GOG 218 trial, where the dose of bevacizumab was 15 mg/kg q21 and concluded that the addition of bevacizumab to the adjuvant treatment was not cost effective. The maintenance treatment improved PFS, but direct and indirect costs raised substantially [17]. "
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