Abstract
BackgroundEvidence from clinical trials suggests that the addition of bevacizumab to chemotherapy in the first-line treatment of patients with HER2-negative metastatic breast cancer improves progression-free survival (PFS) but not overall survival (OS). However, a retrospective analysis of real-world data from the French Comprehensive Cancer Centers (FCCC) through the Epidemiological Strategy and Medical Economics (ESME) Research Program, suggested that in this setting, the addition of bevacizumab may confer a significant benefit in terms of both PFS and OS. A cost-effectiveness analysis was performed to determine the cost-effectiveness of bevacizumab plus paclitaxel versus paclitaxel alone in the first-line treatment of HER2-negative metastatic breast cancer at specialist oncology centers in France.MethodsThe analysis was performed using a three-state Markov model and clinical input data from N = 3426 HER2-negative metastatic breast cancer patients treated with bevacizumab plus paclitaxel or paclitaxel alone. The analysis was performed from a third party payer perspective over a 10-year time horizon; future costs and clinical outcomes were discounted at 4% per annum.ResultsIn the overall population, the addition of bevacizumab to paclitaxel led to incremental gain of 0.72 life years and 0.48 quality-adjusted life years (QALYs) relative to paclitaxel alone. The incremental lifetime cost of the addition of bevacizumab was EUR 27,390, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 56,721 per QALY gained for bevacizumab plus paclitaxel versus paclitaxel alone. In a subgroup of triple negative patients the ICER was EUR 66,874 per QALY gained.ConclusionsThe analysis indicated that the combination of bevacizumab plus paclitaxel is likely to be cost-effective compared with paclitaxel alone for the first-line treatment of HER2-negative metastatic breast cancer in specialized oncology centers in France.
Highlights
Evidence from clinical trials suggests that the addition of bevacizumab to chemotherapy in the first-line treatment of patients with Human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer improves progression-free survival (PFS) but not overall survival (OS)
In the base case analysis for the overall population of HER2 negative patients with metastatic breast cancer, treatment with bevacizumab plus paclitaxel was associated with an incremental gain of 0.48 quality-adjusted life years (QALYs) relative to the use of paclitaxel alone (2.01 Quality-adjusted life year (QALY) for bevacizumab plus paclitaxel versus 1.52 QALYs for paclitaxel alone)
Total lifetime costs were higher for the bevacizumab arm (EUR 54,315 for bevacizumab plus paclitaxel versus EUR 26,925 for paclitaxel) resulting in an incremental cost-effectiveness ratio (ICER) of EUR 56,721 per QALY gained for bevacizumab plus paclitaxel versus paclitaxel alone (Table 2)
Summary
Evidence from clinical trials suggests that the addition of bevacizumab to chemotherapy in the first-line treatment of patients with HER2-negative metastatic breast cancer improves progression-free survival (PFS) but not overall survival (OS). A cost-effectiveness analysis was performed to determine the cost-effectiveness of bevacizumab plus paclitaxel versus paclitaxel alone in the first-line treatment of HER2-negative metastatic breast cancer at specialist oncology centers in France. In addition to the considerable economic burden, breast cancer is the fourth leading cause of cancer-related disability-adjusted life years [3]. In France, in 2015, there were an estimated 54,000 cases and 12,000 deaths from breast cancer, making it the leading cause of cancer-related mortality in women [4]. In France an estimated 70% of women with metastatic breast cancer have HER-negative disease [6] and a regional study reports that 12% of metastatic breast cancers are triple negative [7]
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