Survival and Lifetime Costs Associated With First‐Line Bevacizumab Use in Older Patients With Metastatic Colorectal Cancer

. The objective of this study was to investigate clinical effectiveness and incremental lifetime costs associated with first‐line bevacizumab in older patients with metastatic colorectal cancer (mCRC). Methods. Patients diagnosed with mCRC in 2004–2007 were identified from the Surveillance, Epidemiology, and End Results‐Medicare database and stratified by first‐line treatment (no chemotherapy [CTx], CTx alone, CTx plus bevacizumab). The impact of first‐line bevacizumab on survival was investigated using a propensity score adjusted multivariate Cox proportional hazards model. Mean lifetime costs for each cohort were calculated using Medicare claims for all services rendered between diagnosis and end of follow‐up, adjusting for death and censoring. Results. A total of 4,414 patients (mean age: 77.3 years) were identified, of whom 15% received first‐line bevacizumab. Among first‐line‐treated patients, bevacizumab receipt was associated with improved overall survival (hazard ratio: 0.85 [95% confidence interval: 0.75–0.97]; p = .013), and this benefit was limited to patients who received >1 month of bevacizumab therapy. Median and mean survival were greatest in patients treated with CTx plus bevacizumab relative to CTx alone (CTx plus bevacizumab median 19.4 months [mean 28.0 months] vs. CTx alone median 15.1 months [mean 22.9 months]; p < .001), as were mean lifetime costs (mean per patient cost $143,284 vs. $111,280). Compared with CTx alone, CTx plus bevacizumab was associated with a 5.1‐month increase in mean survival and a $32,004 increase in mean lifetime treatment costs, with an incremental cost of $75,303 per life‐year gained. Conclusion. Bevacizumab use is associated with longer survival than CTx alone in older patients treated in real‐world clinical settings, at an incremental cost of $75,303 per life‐year gained.