Bevacizumab Unlikely to Be Cost Effective in Ovarian Cancer, Canadian Analysis Finds

Ovarian cancer is a leading cause of cancer-related morality, and in Canada, ovarian cancer is estimated to affect approximately 1 in every 71 women. The prognosis for ovarian cancer is poor, and very few therapeutic options are available for women with recurrent ovarian cancer, especially disease that is platinum-resistant.

In a recently published study, researchers sought to determine the cost effectiveness of bevacizumab in treating recurrent ovarian cancer from a Canadian public payer perspective. The investigators compared bevacizumab plus chemotherapy versus chemotherapy alone in patients with platinum-resistant recurrent ovarian cancer based on clinical data from the AURELLIA phase 3 trial.

The study was conducted by evaluating a 3 health-state cohort-based partitioned survival models developed to assess the cost utility of bevacizumab plus chemotherapy versus chemotherapy alone over a 7-year horizon. Researchers reconstructed individual patient data from published Kaplan-Meier curves. Clinical parameters, including progression-free survival and overall survival, were derived from the AURELIA trial. Costs, resource utilization, and utility values from recent Canadian sources were compiled by the study authors and used to populate the model. The results of the study were then presented in incremental cost-utility ratios (ICURs).

In reconstructing the individual patient data, the authors found:

• Total costs for bevacizumab plus chemotherapy were $79,086 (approximately $61,700 USD) versus $54,982 ($42,900 USD) for chemotherapy alone.
• The total estimated quality-adjusted life-years (QALYs) were 1.1055 and 0.9926 for the bevacizumab plus chemotherapy versus chemotherapy alone, respectively.
• The ICUR was estimated to be $213,424 (approximately $166,400 USD) per QALY gained.
• At a willingness-to-pay threshold of $100,000 (approximately $78,000 USD) per QALY gained, the probability of bevacizumab plus chemotherapy being cost effective was 0.

Overall, researchers found that the addition of bevacizumab to a single-agent chemotherapy treatment, although it improved patient outcomes, is unlikely to be cost-effective in this patient population. This result is due to bevacizumab plus chemotherapy not being considered cost-effective at willingness-to-pay thresholds below approximately $200,000 (approximately $155,900 USD) per QALY gained. However, the study’s authors also note that these results provide some preliminary validation for the use of individual patient data-reconstruction techniques in pharmacoeconomic evaluation.

Reference

Ball G, Xie F, Tarride JE. Economic evaluation of bevacizumab for treatment of platinum-resistant recurrent ovarian cancer in Canada. Published online May 29, 2017. Pharmacoeconomics. doi: 10.1007/s41669-017-0030-7.