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. 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

Daniel A Goldstein  1 , Qiushi Chen  2 , Turgay Ayer  2 , David H Howard  2 , Joseph Lipscomb  2 , Bassel F El-Rayes  2 , Christopher R Flowers  2
Affiliations

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

Daniel A Goldstein et al. J Clin Oncol. .

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.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Markov model diagram for first-line model. FOLFIRI, fluorouracil plus irinotecan; FOLFOX, fluorouracil plus oxaliplatin; mCRC, metastatic colorectal cancer.
Fig 2.
Fig 2.
Markov model diagram for second-line model. FOLFIRI, fluorouracil plus irinotecan; FOLFOX, fluorouracil plus oxaliplatin; mCRC, metastatic colorectal cancer.
Fig 3.
Fig 3.
Univariable sensitivity analyses of variables with greatest influence on model. Bar shaded lighter blue indicates that actual value is beyond range of axis. FOLFIRI, fluorouracil plus irinotecan; FOLFOX, fluorouracil plus oxaliplatin; OS, overall survival; PFS, progression-free survival; QALY, quality-adjusted life-year.
Fig 4.
Fig 4.
Scatter plot of probabilistic sensitivity analysis. Red and gray lines indicate threshold of willingness to pay (WTP) of $50,000 and $100,000 per quality-adjusted life-year (QALY), respectively. Each point in scatterplot corresponds to one sample of parameter values. Points above reference line indicate higher incremental cost-effectiveness ratio than threshold value.
Fig A1.
Fig A1.
(A) Progression-free survival (PFS) inference and external validation for arm treated with fluorouracil plus oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (XELOX), with addition of bevacizumab (data adapted,), and (B) internal validation with simulation results for arm treated with FOLFOX or XELOX in first-line model (data adapted,). (C) Internal validation of overall survival (OS) in second-line model (data adapted).
Fig A2.
Fig A2.
Cost-effectiveness acceptability curve.
See this image and copyright information in PMC

Comment in

References

    1. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64:104–117. - PubMed
    1. Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–128. - PMC - PubMed
    1. Goldberg RM, Sargent DJ, Morton RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30. - PubMed
    1. Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26:2006–2012. - PubMed
    1. Hochster HS, Hart LL, Ramanathan RK, et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: Results of the TREE study. J Clin Oncol. 2008;26:3523–3529. - PubMed

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