Adding Bevacizumab To Single-Agent Chemotherapy For The Treatment Of Platinum-Resistant Recurrent Ovarian Cancer: A Cost-Effectiveness Analysis Of The Aurelia Trial.

Objectives: AURELIA was a randomized phase III trial of adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer that demonstrated improved progression-free survival (PFS) in the bevacizumab + chemotherapy arm compared with chemotherapy alone. The goal of this study was to evaluate the cost-effectiveness of adding bevacizumab to single-agent chemotherapy in the treatment of platinum-resistant recurrent ovarian cancer.Methods: A decision tree model was constructed to evaluate the cost-effectiveness of adding bevacizumab to standard treatment with single-agent chemotherapy based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and PFS were modeled over a 15-month period. All model inputs were extracted from published peer-reviewed literature and public sources. Costs and QALYs were discounted at an annual 3% rate. All costs were adjusted to 2015 US dollars. Incremental cost-effectiveness ratios (ICERs) per QALY gained and ICERs per progression-free life year saved (PF-LYS) were calculated. Probabilistic sensitivity analyses were performed to evaluate the robustness of results.Results: The ICER associated with bevacizumab + chemotherapy is $285,624 per QALY gained and $151,059 per PF-LYS. At a willingness-to-pay (WTP) threshold of $50,000/QALY, adding bevacizumab to single-agent chemotherapy is not cost-effective in this patient population. Even at a WTP threshold of $100,000/QALY, bevacizumab + chemotherapy is not cost-effective. These findings are robust to deterministic and probabilistic sensitivity analyses.Conclusions: Despite gains in QALY and PFS, the addition of bevacizumab to single-agent chemotherapy for treatment of platinum-resistant recurrent ovarian cancer is not cost-effective at a WTP threshold of $50,000/QALY. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this population of patients. Objectives: AURELIA was a randomized phase III trial of adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer that demonstrated improved progression-free survival (PFS) in the bevacizumab + chemotherapy arm compared with chemotherapy alone. The goal of this study was to evaluate the cost-effectiveness of adding bevacizumab to single-agent chemotherapy in the treatment of platinum-resistant recurrent ovarian cancer. Methods: A decision tree model was constructed to evaluate the cost-effectiveness of adding bevacizumab to standard treatment with single-agent chemotherapy based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and PFS were modeled over a 15-month period. All model inputs were extracted from published peer-reviewed literature and public sources. Costs and QALYs were discounted at an annual 3% rate. All costs were adjusted to 2015 US dollars. Incremental cost-effectiveness ratios (ICERs) per QALY gained and ICERs per progression-free life year saved (PF-LYS) were calculated. Probabilistic sensitivity analyses were performed to evaluate the robustness of results. Results: The ICER associated with bevacizumab + chemotherapy is $285,624 per QALY gained and $151,059 per PF-LYS. At a willingness-to-pay (WTP) threshold of $50,000/QALY, adding bevacizumab to single-agent chemotherapy is not cost-effective in this patient population. Even at a WTP threshold of $100,000/QALY, bevacizumab + chemotherapy is not cost-effective. These findings are robust to deterministic and probabilistic sensitivity analyses. Conclusions: Despite gains in QALY and PFS, the addition of bevacizumab to single-agent chemotherapy for treatment of platinum-resistant recurrent ovarian cancer is not cost-effective at a WTP threshold of $50,000/QALY. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this population of patients.