Wysham Weiya Z, Schaffer Elisabeth M, Coles Theresa, Roque Dario R, Wheeler Stephanie B, Kim Kenneth H
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, United States.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States.
Gynecol Oncol. 2017 May;145(2):340-345. doi: 10.1016/j.ygyno.2017.02.039. Epub 2017 Mar 11.
AURELIA, a randomized phase III trial of adding bevacizumab (B) to single agent chemotherapy (CT) for the treatment of platinum-resistant recurrent ovarian cancer, demonstrated improved progression free survival (PFS) in the B+CT arm compared to CT alone. We aimed to evaluate the cost effectiveness of adding B to CT in the treatment of platinum-resistant recurrent ovarian cancer.
A decision tree model was constructed to evaluate the cost effectiveness of adding bevacizumab (B) to single agent chemotherapy (CT) based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and progression free survival (PFS) were modeled over fifteen months. Model inputs were extracted from published literature and public sources. Incremental cost effectiveness ratios (ICERs) per QALY gained and ICERs per progression free life year saved (PF-LYS) were calculated. One-way sensitivity analyses were performed to evaluate the robustness of results.
The ICER associated with B+CT is $410,455 per QALY gained and $217,080 per PF-LYS. At a willingness to pay (WTP) threshold of $50,000/QALY, adding B to single agent CT is not cost effective for this patient population. Even at a WTP threshold of $100,000/QALY, B+CT is not cost effective. These findings are robust to sensitivity analyses.
Despite gains in QALY and PFS, the addition of B to single agent CT for treatment of platinum-resistant recurrent ovarian cancer is not cost effective. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this patient population.
AURELIA试验是一项随机III期试验，旨在评估在单药化疗（CT）基础上加用贝伐单抗（B）治疗铂耐药复发性卵巢癌的疗效，结果显示与单纯CT相比，B+CT组的无进展生存期（PFS）有所改善。我们旨在评估在CT基础上加用B治疗铂耐药复发性卵巢癌的成本效益。
基于AURELIA试验的分组构建决策树模型，以评估在单药化疗（CT）基础上加用贝伐单抗（B）的成本效益。对15个月内的成本、质量调整生命年（QALY）和无进展生存期（PFS）进行建模。模型输入数据取自已发表的文献和公共来源。计算每获得一个QALY的增量成本效益比（ICER）以及每挽救一个无进展生命年（PF-LYS）的ICER。进行单向敏感性分析以评估结果的稳健性。
与B+CT相关的ICER为每获得一个QALY 410,455美元，每挽救一个PF-LYS 217,080美元。在每QALY支付意愿（WTP）阈值为50,000美元的情况下，对于该患者群体，在单药CT基础上加用B不具有成本效益。即使在每QALY WTP阈值为100,000美元时，B+CT也不具有成本效益。这些结果在敏感性分析中具有稳健性。
尽管在QALY和PFS方面有所获益，但在单药CT基础上加用B治疗铂耐药复发性卵巢癌不具有成本效益。在为该患者群体开化疗处方时，应考虑治疗相关的益处、风险和成本。
