Open AccessBevacizumab for Metastatic Colorectal Cancer: A Global Cost‐Effectiveness Analysis
Author(s) -
Goldstein Daniel A.,
Chen Qiushi,
Ayer Turgay,
Chan Kelvin K. W.,
Virik Kiran,
Hammerman Ariel,
Brenner Baruch,
Flowers Christopher R.,
Hall Peter S.
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2016-0455
Subject(s) - medicine , bevacizumab , colorectal cancer , incremental cost effectiveness ratio , quality adjusted life year , cost effectiveness , cost effectiveness analysis , willingness to pay , cost–benefit analysis , adverse effect , oncology , demography , chemotherapy , cancer , ecology , risk analysis (engineering) , economics , biology , microeconomics , sociology
Background In the U.S., the addition of bevacizumab to first‐line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality‐adjusted life years (QALYs) at an incremental cost‐effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost‐effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. Methods We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country‐specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one‐way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. Results Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost‐effective in any country at a willingness to pay threshold of $150,000 per QALY. Conclusion The addition of bevacizumab to first‐line chemotherapy for mCRC consistently fails to be cost‐effective in all five countries. There are large differences in cost‐effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. Implications for Practice The cost‐effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost‐effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.