P-F Zhang1,2, F Wen1,2, J Zhou1,2, J-X Huang1,2, K-X Zhou1,2, Q-J Wu1,2, X-Y Wang1,2, M-X Zhang1,2, W-T Liao1,2, Q Li3,4. 1. Department of Medical Oncology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. 2. West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China. 3. Department of Medical Oncology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. keythera@126.com. 4. West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China. keythera@126.com.
Abstract
PURPOSE: The aim of the study was to evaluate the cost-effectiveness of capecitabine plus bevacizumab compared with capecitabine alone in elderly patients with metastatic colorectal cancer (CRC) from a Chinese societal perspective. METHODS: A decision-analytic Markov model was conducted to simulate the process of metastatic CRC. Three distinct health states: progression-free survival (PFS), progressive disease and death were included. Clinical data were derived from the AVEX trial. Health effectiveness was denoted in quality-adjusted life years (QALYs) and health utilities were derived from previously published studies. Incremental cost-effectiveness ratio (ICER) was regarded as the primary endpoint and willingness-to-pay (WTP) threshold was set at $26,753.37/QALY (3 × per capita GDP of China, 2017). One-way sensitivity analyses and probabilistic sensitivity analysis were also performed to explore the parameters uncertainty in the study. RESULTS: Over a 10-year life horizon, capecitabine plus bevacizumab gained 1.14 QALYs at an average cost of $21,609.48, while the effectiveness and cost of capecitabine group were 0.99 QALYs and $7274.83, respectively. The ICER between the two groups was $95,564.33/QALY. Parameters that mostly influenced the results of the model were utility of PFS state, duration of PFS state for capecitabine plus bevacizumab, total cost of PFS state for capecitabine plus bevacizumab and price of bevacizumab. The probabilities of capecitabine plus bevacizumab and capecitabine as the dominant option were 0% and 100% at the WTP threshold of $26,753.37/QALY. CONCLUSIONS: The results of the study showed that capecitabine plus bevacizumab is unlikely to be a cost-effective treatment option for elderly patients with metastatic CRC.
PURPOSE: The aim of the study was to evaluate the cost-effectiveness of capecitabine plus bevacizumab compared with capecitabine alone in elderly patients with metastatic colorectal cancer (CRC) from a Chinese societal perspective. METHODS: A decision-analytic Markov model was conducted to simulate the process of metastatic CRC. Three distinct health states: progression-free survival (PFS), progressive disease and death were included. Clinical data were derived from the AVEX trial. Health effectiveness was denoted in quality-adjusted life years (QALYs) and health utilities were derived from previously published studies. Incremental cost-effectiveness ratio (ICER) was regarded as the primary endpoint and willingness-to-pay (WTP) threshold was set at $26,753.37/QALY (3 × per capita GDP of China, 2017). One-way sensitivity analyses and probabilistic sensitivity analysis were also performed to explore the parameters uncertainty in the study. RESULTS: Over a 10-year life horizon, capecitabine plus bevacizumab gained 1.14 QALYs at an average cost of $21,609.48, while the effectiveness and cost of capecitabine group were 0.99 QALYs and $7274.83, respectively. The ICER between the two groups was $95,564.33/QALY. Parameters that mostly influenced the results of the model were utility of PFS state, duration of PFS state for capecitabine plus bevacizumab, total cost of PFS state for capecitabine plus bevacizumab and price of bevacizumab. The probabilities of capecitabine plus bevacizumab and capecitabine as the dominant option were 0% and 100% at the WTP threshold of $26,753.37/QALY. CONCLUSIONS: The results of the study showed that capecitabine plus bevacizumab is unlikely to be a cost-effective treatment option for elderly patients with metastatic CRC.
Authors: Hedwig M Blommestein; Silvia G R Verelst; Saskia de Groot; Peter C Huijgens; Pieter Sonneveld; Carin A Uyl-de Groot Journal: Eur J Haematol Date: 2015-05-07 Impact factor: 2.997
Authors: Fairooz F Kabbinavar; Julie Hambleton; Robert D Mass; Herbert I Hurwitz; Emily Bergsland; Somnath Sarkar Journal: J Clin Oncol Date: 2005-05-02 Impact factor: 44.544
Authors: Daniel A Goldstein; Qiushi Chen; Turgay Ayer; David H Howard; Joseph Lipscomb; Bassel F El-Rayes; Christopher R Flowers Journal: J Clin Oncol Date: 2015-02-17 Impact factor: 44.544
Authors: Niall C Tebbutt; Kate Wilson; Val J Gebski; Michelle M Cummins; Diana Zannino; Guy A van Hazel; Bridget Robinson; Adam Broad; Vinod Ganju; Stephen P Ackland; Garry Forgeson; David Cunningham; Mark P Saunders; Martin R Stockler; Yujo Chua; John R Zalcberg; R John Simes; Timothy J Price Journal: J Clin Oncol Date: 2010-06-01 Impact factor: 44.544
Authors: Derek J Jonker; Chris J O'Callaghan; Christos S Karapetis; John R Zalcberg; Dongsheng Tu; Heather-Jane Au; Scott R Berry; Marianne Krahn; Timothy Price; R John Simes; Niall C Tebbutt; Guy van Hazel; Rafal Wierzbicki; Christiane Langer; Malcolm J Moore Journal: N Engl J Med Date: 2007-11-15 Impact factor: 91.245