Is FDA Approved Bevacizumab Cost-Effective in the Setting of Platinum-Resistant Recurrent Ovarian Cancer? [18

Abstract

INTRODUCTION: The recent FDA approval of inclusion of bevacizumab (BEV) in the treatment of platinum-resistant recurrent ovarian cancer will likely lead to more widespread adoption of this intervention. We assessed the cost effectiveness of this expensive treatment for this specific indication. METHODS: A cost effectiveness decision model was constructed using results from AURELIA, a phase III randomized trial comparing BEV plus cytotoxic chemotherapy versus chemotherapy alone in patients with platinum-resistant recurrent ovarian cancer. The BEV arm of AURELIA had improved progression free survival and quality of life (QOL). Costs, paracentesis rates, and adverse events were incorporated. RESULTS: Inclusion of BEV in the treatment of platinum-resistant recurrent ovarian cancer costs on average $26,790 more than cytotoxic chemotherapy alone when 15 mg/kg dosing is used and $40,813 more when biweekly 10 mg/kg is used. The incremental cost-effectiveness ratio (ICER) per progression-free life year saved (PF-LYS) is $146K with 10 mg/kg dosing and $96K with 15 mg/kg dosing. In sensitivity analysis, the ICER drops below a willingness-to-pay (WTP) threshold of $100K when greater than 68% of patients receive salvage single agent BEV. Incorporating better QOL in the BEV arm based on AURELIA improves the ICER in both dosing regimens, but does not lower the ICER below $100K at the 10 mg/kg dose. CONCLUSION/IMPLICATIONS: Our results suggest that incorporation of BEV using the 15 mg/kg regimen is cost-effective based on the common WTP threshold ICER of $100K. In light of FDA approval for this indication, evidence for cost-effectiveness further supports utilization in women with platinum-resistant recurrent ovarian cancer.