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.
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.
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.
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.
San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX
Financial Disclosure: The authors did not report any potential conflicts of interest.