Bevacizumab for metastatic colorectal cancer: A global cost-effectiveness analysis

Daniel A. Goldstein, Qiushi Chen, Turgay Ayer, Kelvin K.W. Chan, Kiran Virik, Ariel Hammerman, Baruch Brenner, Christopher R. Flowers, Peter S. Hall

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background. In the U.S., the addition of bevacizumab to firstline 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 countryspecific 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.

Original languageEnglish (US)
Pages (from-to)694-699
Number of pages6
JournalOncologist
Volume22
Issue number6
DOIs
StatePublished - Jun 2017

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Colorectal Neoplasms
Costs and Cost Analysis
Israel
Canada
Drug Therapy
Internationality
Health Care Costs
Uncertainty
Bevacizumab
Quality of Life
Pharmaceutical Preparations
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Goldstein, D. A., Chen, Q., Ayer, T., Chan, K. K. W., Virik, K., Hammerman, A., ... Hall, P. S. (2017). Bevacizumab for metastatic colorectal cancer: A global cost-effectiveness analysis. Oncologist, 22(6), 694-699. https://doi.org/10.1634/theoncologist.2016-0455
Goldstein, Daniel A. ; Chen, Qiushi ; Ayer, Turgay ; Chan, Kelvin K.W. ; Virik, Kiran ; Hammerman, Ariel ; Brenner, Baruch ; Flowers, Christopher R. ; Hall, Peter S. / Bevacizumab for metastatic colorectal cancer : A global cost-effectiveness analysis. In: Oncologist. 2017 ; Vol. 22, No. 6. pp. 694-699.
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abstract = "Background. In the U.S., the addition of bevacizumab to firstline 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 countryspecific 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.",
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Goldstein, DA, Chen, Q, Ayer, T, Chan, KKW, Virik, K, Hammerman, A, Brenner, B, Flowers, CR & Hall, PS 2017, 'Bevacizumab for metastatic colorectal cancer: A global cost-effectiveness analysis', Oncologist, vol. 22, no. 6, pp. 694-699. https://doi.org/10.1634/theoncologist.2016-0455

Bevacizumab for metastatic colorectal cancer : A global cost-effectiveness analysis. / Goldstein, Daniel A.; Chen, Qiushi; Ayer, Turgay; Chan, Kelvin K.W.; Virik, Kiran; Hammerman, Ariel; Brenner, Baruch; Flowers, Christopher R.; Hall, Peter S.

In: Oncologist, Vol. 22, No. 6, 06.2017, p. 694-699.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bevacizumab for metastatic colorectal cancer

T2 - A global cost-effectiveness analysis

AU - Goldstein, Daniel A.

AU - Chen, Qiushi

AU - Ayer, Turgay

AU - Chan, Kelvin K.W.

AU - Virik, Kiran

AU - Hammerman, Ariel

AU - Brenner, Baruch

AU - Flowers, Christopher R.

AU - Hall, Peter S.

PY - 2017/6

Y1 - 2017/6

N2 - Background. In the U.S., the addition of bevacizumab to firstline 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 countryspecific 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.

AB - Background. In the U.S., the addition of bevacizumab to firstline 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 countryspecific 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.

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