A Trial-Based Assessment of the Cost-Utility of Bevacizumab and Chemotherapy versus Chemotherapy Alone for Advanced Non-Small Cell Lung Cancer

Objectives: Bevacizumab is approved for treatment of advanced non-small cell lung cancer (NSCLC) in combination with chemotherapy based on a 2-month median survival benefit demonstrated in one randomized trial. The cost-utility of adding bevacizumab to chemotherapy in advanced NSCLC remains unknown. We evaluated the cost-utility of bevacizumab added to chemotherapy in patients with advanced NSCLC. Methods: We developed a Markov model to estimate quality-adjusted life years (QALYs) and direct medical costs from the US payer perspective in patients treated with bevacizumab plus chemotherapy and compared these outcomes with patients treated with chemotherapy alone. We populated the model with survival and toxicity data from the clinical trial that compared the two strategies. We obtained utilities from a literature search and unit costs from Medicare. We discounted QALYs and costs at 3% per year. We addressed uncertainty with one-way and probabilistic sensitivity analyzes. Results: Compared with chemo-therapy alone, bevacizumab and chemotherapy increased mean QALYs by 0.13, at an incremental life-time cost of US$72,000 per patient. The incremental cost-utility ratio (ICUR) was US$560,000/QALY. The ICUR was most sensitive to the survival on bevacizumab treatment, the drug costs of bevacizumab, and the utility of stable disease on treatment. At a threshold of US$100,000/QALY, the addition of bevacizumab had a 0.2% probability of being cost-effective. Conclusions: Bevacizumab does not appear to be cost-effective when added to chemotherapy in patients with advanced NSCLC, based on approximate cost-effectiveness thresholds that have been identified in the United States. These results may inform decision-makers about resource allocation for NSCLC care.