Is bevacizumab a cost‑effective regimen for treating cerebral radiation necrosis in the United States?: Cost-effectiveness analysis of radionecrosis medications.

Abstract

Bevacizumab has been demonstrated to have superior efficacy in the treatment of cerebral radiation necrosis (CRN), but its' high cost may exacerbate the disease burden. This study aimed to assess the cost-effectiveness of bevacizumab in comparison with corticosteroids for treating CRN from the US payers' perspective. Decision tree models were constructed to simulate the process of bevacizumab and corticosteroids in CRN short-term and long-term therapy. Critical clinical data were derived from the NCT01621880 trial. Costs and utility values were obtained from the US official websites and published literatures. The main outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of models. In the short-term and long-term models, bevacizumab added 0.11 (0.46 vs 0.35) and 0.16 (0.54 vs 0.38) QALYs compared with corticosteroids therapy, with corresponding incremental costs of $12,351 and $23,253, respectively. The resultant ICERs were $112,987/QALY and $150,245/QALY for short-term and long-term treatment, respectively. The one-way sensitivity analysis indicated that utility value of non-recurrence status, body weight and bevacizumab price per cycle were the most influential factors for ICER of both models. At the willingness-to-pay threshold of $150,000/QALY in the US, the probabilities of bevacizumab being cost-effective for CRN short and long-term treatment were 63.9% and 49%, respectively. Compared with corticosteroids, bevacizumab is an economical alternative for CRN short-term treatment from the US payers' perspective, while long-term therapy draws an opposite conclusion.