Medicare Modeling Shows Major Savings With Biosimilar Bevacizumab Use

Rising cancer drug costs have pushed payers to search for practical ways to stretch limited budgets, and new modeling data indicate that a broad shift to biosimilar bevacizumab could give Medicare considerably more room to treat older adults with metastatic colorectal cancer (mCRC) and metastatic non-squamous non–small cell lung cancer (mNSCLC) without compromising care.

Biosimilar bevacizumab offers significant cost savings for Medicare, enhancing treatment access for metastatic colorectal and lung cancer patients without increasing spending. | Image credit: japhoto - stock.adobe.com

The study, published in the Journal of Medical Economics, assessed whether converting people from the reference bevacizumab product to several FDA-approved biosimilars could improve cost-efficiency in first-line treatment. Investigators conducted the analysis to quantify both direct savings and the number of additional individuals whose therapy could be funded using those savings on a budget-neutral basis—an increasingly relevant question as Medicare continues to spend heavily on biologics for solid tumors.

Researchers developed a simulation model rooted in a Medicare payer perspective, focusing exclusively on drug acquisition costs rather than clinical outcomes. Because biosimilars are expected to match their reference biologic in safety and efficacy, the analysis centered on pricing differences across bevacizumab-bvzr, bevacizumab-awwb, bevacizumab-adcd, and bevacizumab-maly. Costs were derived from 2024 average sales price (ASP) data, using Medicare’s reimbursement markups for originator and biosimilar products.

To estimate the number of beneficiaries likely to receive treatment, the model incorporated Medicare enrollment data, SEER incidence rates among adults aged 65 years and older, and published estimates describing the proportion of individuals who begin systemic therapy. This approach produced an estimated 6,579 people with mCRC and 3,843 people with mNSCLC who would receive bevacizumab-based regimens in an average year.

Modeled treatment reflected guideline-concordant regimens. People with mCRC were assigned bevacizumab-containing FOLFOX for initiation and maintenance. Those with mNSCLC were modeled on bevacizumab with paclitaxel plus carboplatin during induction, followed by bevacizumab alone in the maintenance phase. Dosing and vial counts were calculated using average weight and body surface area from prior research, aligning drug utilization with typical patient characteristics in the Medicare population.

Across both cancers, conversion to bevacizumab-bvzr generated the strongest cost-efficiency profile. In mCRC, switching produced per-patient per-month (PPPM) savings of $4,205, reflecting a 68% reduction relative to originator-based care. When applied to the full modeled population, monthly savings reached $27.7 million. Using these savings, Medicare could fund 13,887 additional patient-months of bevacizumab-bvzr plus FOLFOX on a budget-neutral basis. The “number needed to convert” (NNC) was 47, meaning that converting 47 individuals to the biosimilar would free enough funds to treat 100 more.

Savings were even greater for people with mNSCLC, given the higher baseline cost of originator bevacizumab in lung cancer regimens. Here, PPPM savings totaled $8,410, and full cohort monthly savings reached $32.3 million—a 70% reduction compared with the reference product. These savings could support 8,959 additional patient-months of bevacizumab-bvzr–based therapy. The NNC was 43, the lowest of all biosimilars evaluated.

Alternative biosimilars did produce savings, but to a smaller degree. Bevacizumab-awwb generated meaningful reductions—with PPPM savings of $3,876 in mCRC and $7,752 in mNSCLC—while bevacizumab-adcd offered minimal savings in both conditions.

The authors noted several limitations. The study assumed steady patient counts across the year, although treatment initiation and discontinuation vary in real-world practice. ASP values change quarterly, which may shift relative cost-efficiency over time. The analysis also relied on national averages for weight-based dosing, which may not reflect local population characteristics. Finally, because the model excluded administration or site-of-care costs, total spending differences may differ in real-world scenarios.

Even with these constraints, the findings highlight the potential for biosimilars to extend access to oncology biologics within fixed budgets—an issue of growing importance as Medicare’s oncology expenditures continue to rise. For bevacizumab, the model suggests that bevacizumab-bvzr may offer the most cost-efficient option among available biosimilars, allowing payers to treat more people with cancer without increasing overall spending.

Reference

Roth JA, Kratochvil D, Dorman S, Bernauer M. Cost-efficiency and expanded access modeling of conversion to biosimilar bevacizumab in metastatic colorectal and non-squamous non-small cell lung cancer in Medicare. J Med Econ. 2025;28(1):378-386. doi:10.1080/13696998.2025.2474884