mCRC: capecitabine plus bevacizumab not cost-effective

  • Sherman SK & al.
  • JAMA Oncol
  • 29 Nov 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In order to be a cost-effective maintenance therapy for metastatic colorectal cancer (mCRC), the combination of capecitabine and bevacizumab would have to be 93% cheaper.

Why this matters

  • The finding could help policymakers and inform payment negotiation.

Study design

  • Markov model of outcomes data from the CAIRO phase 3 randomized clinical trial of 558 adults in the Netherlands.
  • Funding: None disclosed.

Key results

  • Patients lived an average of 2.88 months longer in the treatment group than in the observation group, at an additional cost of $105,217 (or $438,394 per life-year).
  • Per-cycle drug costs were $6173.35 for capecitabine plus bevacizumab, including $62.05 for complication treatment during observation and $311.99 for complication treatment during maintenance therapy.
  • Capecitabine + bevacizumab maintenance therapy led to a mean of 1.34 quality-adjusted life years (QALYs) vs 1.20 QALYs for observation, with a cost-effectiveness ratio of $725,601 per QALY.
  • To reduce this cost to the median household income of $59,039, the combined cost for 3-week capecitabine plus bevacizumab cycle would have to be reduced from $6173 to $452.

Limitations

  • Calculations were made based on Medicare.
  • Data from a clinical trial may not reflect real-world outcomes and costs.

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