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J Clin Oncol. 2015 Apr 1;33(10):1112-8. doi: 10.1200/JCO.2014.58.4904. Epub 2015 Feb 17.

First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: a United States-based cost-effectiveness analysis.

Author information

1
Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA. dgolds8@emory.edu.
2
Daniel A. Goldstein, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.

Abstract

PURPOSE:

The addition of bevacizumab to fluorouracil-based chemotherapy is a standard of care for previously untreated metastatic colorectal cancer. Continuation of bevacizumab beyond progression is an accepted standard of care based on a 1.4-month increase in median overall survival observed in a randomized trial. No United States-based cost-effectiveness modeling analyses are currently available addressing the use of bevacizumab in metastatic colorectal cancer. Our objective was to determine the cost effectiveness of bevacizumab in the first-line setting and when continued beyond progression from the perspective of US payers.

METHODS:

We developed two Markov models to compare the cost and effectiveness of fluorouracil, leucovorin, and oxaliplatin with or without bevacizumab in the first-line treatment and subsequent fluorouracil, leucovorin, and irinotecan with or without bevacizumab in the second-line treatment of metastatic colorectal cancer. Model robustness was addressed by univariable and probabilistic sensitivity analyses. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs).

RESULTS:

Using bevacizumab in first-line therapy provided an additional 0.10 QALYs (0.14 life-years) at a cost of $59,361. The incremental cost-effectiveness ratio was $571,240 per QALY. Continuing bevacizumab beyond progression provided an additional 0.11 QALYs (0.16 life-years) at a cost of $39,209. The incremental cost-effectiveness ratio was $364,083 per QALY. In univariable sensitivity analyses, the variables with the greatest influence on the incremental cost-effectiveness ratio were bevacizumab cost, overall survival, and utility.

CONCLUSION:

Bevacizumab provides minimal incremental benefit at high incremental cost per QALY in both the first- and second-line settings of metastatic colorectal cancer treatment.

PMID:
25691669
PMCID:
PMC4881313
DOI:
10.1200/JCO.2014.58.4904
[Indexed for MEDLINE]
Free PMC Article

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