Chan John K, Herzog Thomas J, Hu Lilian, Monk Bradley J, Kiet Tuyen, Blansit Kevin, Kapp Daniel S, Yu Xinhua
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA; Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA; Columbia University School of Medicine, New York, New York, USA; California Pacific Medical Center Research Institute, San Francisco, California, USA; Division of Gynecologic Oncology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Oncologist. 2014 May;19(5):523-7. doi: 10.1634/theoncologist.2013-0322. Epub 2014 Apr 10.
The objective of this study was to evaluate a cost-effectiveness strategy of bevacizumab in a subset of high-risk advanced ovarian cancer patients with survival benefit. Methods. A subset analysis of the International Collaboration on Ovarian Neoplasms 7 trial showed that additions of bevacizumab (B) and maintenance bevacizumab (mB) to paclitaxel (P) and carboplatin (C) improved the overall survival (OS) of high-risk advanced cancer patients. Actual and estimated costs of treatment were determined from Medicare payment. Incremental cost-effectiveness ratio per life-year saved was established. Results. The estimated cost of PC is $535 per cycle; PCB + mB (7.5 mg/kg) is $3,760 per cycle for the first 6 cycles and then $3,225 per cycle for 12 mB cycles. Of 465 high-risk stage IIIC (>1 cm residual) or stage IV patients, the previously reported OS after PC was 28.8 months versus 36.6 months in those who underwent PCB + mB. With an estimated 8-month improvement in OS, the incremental cost-effectiveness ratio of B was $167,771 per life-year saved. Conclusion. In this clinically relevant subset of women with high-risk advanced ovarian cancer with overall survival benefit after bevacizumab, our economic model suggests that the incremental cost of bevacizumab was approximately $170,000.
本研究的目的是评估贝伐单抗在一部分具有生存获益的高危晚期卵巢癌患者中的成本效益策略。方法。卵巢癌国际协作组7试验的亚组分析显示，在紫杉醇（P）和卡铂（C）基础上加用贝伐单抗（B）和维持使用贝伐单抗（mB）可改善高危晚期癌症患者的总生存期（OS）。治疗的实际成本和估算成本由医疗保险支付确定。计算每挽救一个生命年的增量成本效益比。结果。PC方案的估算成本为每周期535美元；PCB + mB（7.5 mg/kg）方案在前6个周期为每周期3760美元，随后12个mB周期为每周期3225美元。在465例高危IIIC期（残留>1 cm）或IV期患者中，先前报道PC方案后的OS为28.8个月，而接受PCB + mB方案的患者为36.6个月。OS估计改善8个月，B方案的增量成本效益比为每挽救一个生命年167,771美元。结论。在这一具有临床相关性的高危晚期卵巢癌女性亚组中，贝伐单抗治疗后具有总生存获益，我们的经济模型表明，贝伐单抗的增量成本约为170,000美元。
