Economic Evaluation Of Bevacizumab Combined With Chemotherapy As A Second-line Treatment For Metastatic Colorectal Cancer

IntroductionPreviously published literatures have shown that bevacizumab has significantly better efficacy and tolerance in metastatic colorectal cancer (mCRC). Currently, there are no pharmacoeconomics study of the second-line treatment of mCRC in China. Therefore, we conducted a study to analyse the cost-effectiveness of the second-line chemotherapy regimen that adding bevacizumab to the standard fluoropyrimidine/capecitabine-based chemotherapy in mCRC patients to provide valuable references of rational、safe and economic use of anticancer drug for patients and medical decision maker.MethodsBased on the data and information from the ML18147trial and a large3A grade hospital, a Markov model was developed in TreeAge Pro2009software to analysis the cost-effectiveness of bevacizumab, from the prospective of Chinese health care system. Increamental cost-effectiveness ratios (ICER) was used as evaluation indicator. One-way sensitivity and probability sensitivity analyses were performed to allow for uncertainties within the model parameters and to estimate the model’s robustness.ResultThe median progression-free survival obtained from the model was11.9months (11.2months was reported in the trial) in the bevacizumab group and10.1months (10.1months was reported in the trial) in the chemotherapy group. For patients in the bevacizumab group, there was a gain of0.11QALY at a cost increase of﹩26,924.50, which resulted in a discounted ICER of﹩242,395.25/QALY, with a6-month bevacizumab patient payment assistance program. The results were robust with regard to the model parameter changes but sensitive to the utility of the progression-free state and the unit cost of bevacizumab.ConclusionsGiven the high acquisition costs of bevacizumab for mCRC patients, bevacizumab combined with standard second-line chemotherapy administration is not a cost-effective option in China. However, under circumstance of a more preferential patient assistance policy, reduced acquisition costs of bevacizumab, or a higher willingness-to-pay (WTP), bevacizumab combined standard second-line chemotherapy might be a better option.