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Bevacizumab for metastatic colorectal cancer: A global cost-effectiveness analysis

Goldstein, DA, Chen, Q, Ayer, T, Chan, KKW, Virik, K, Hammerman, A, Brenner, B, Flowers, CR and Hall, PS 2017 , 'Bevacizumab for metastatic colorectal cancer: A global cost-effectiveness analysis' , Oncologist, vol. 22, no. 6 , pp. 694-699 , doi: 10.1634/theoncologist.2016-0455.

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Abstract

Background:In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel.Methods:We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties.Results:Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY.Conclusion:The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers.Implications for practice:The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.

Item Type: Article
Authors/Creators:Goldstein, DA and Chen, Q and Ayer, T and Chan, KKW and Virik, K and Hammerman, A and Brenner, B and Flowers, CR and Hall, PS
Keywords: chemotherapy, colorectal cancer, cost, cost‐effectiveness, economics, value
Journal or Publication Title: Oncologist
Publisher: AlphaMed Press
ISSN: 1083-7159
DOI / ID Number: 10.1634/theoncologist.2016-0455
Copyright Information:

Copyright 2017 AlphaMed Press

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