Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
PLoS One. 2018 Apr 9;13(4):e0195134. doi: 10.1371/journal.pone.0195134. eCollection 2018.
Currently, in Belgium, bevacizumab is reimbursed for ovarian cancer patients, based on a contract between the Minister and the manufacturer including confidential agreements. This reimbursement will be re-evaluated in 2018.
To support the reimbursement reassessment by calculating the cost-effectiveness of bevacizumab: (1) in addition to first-line chemotherapy; (2) in the treatment of recurrent ovarian cancer (platinum-sensitive or platinum-resistant).
A health economic model has been developed for the Belgian situation according to the Belgian guidelines for economic evaluations. The lifetime Markov model was set up from the perspective of the health care payer (government and patient), including direct healthcare related costs. Results are expressed as the extra costs per quality-adjusted life year (QALY). Calculations were based on results of four international trials. Both probabilistic and one-way sensitivity analyses were performed.
Incremental cost-effectiveness ratios (ICERs) of first-line bevacizumab are on average 158 000/QALY (GOG-0218 trial) and 443 000/QALY (ICON7 trial). The most favourable scenario is based on the stage IV subgroup of the GOG-0218 trial (€52 000/QALY). Since subgroup findings are often exploratory and require confirmatory studies, results of the economic evaluation based on this subgroup analysis should be considered with caution. For second-line bevacizumab, ICERs are on average €587 000/QALY (OCEANS trial) and €172 000/QALY (AURELIA trial). Sensitivity analysis shows that results are most sensitive to the price of bevacizumab.
From a health economic perspective, ICERs of bevacizumab are relatively high. The most favourable results are found for first-line treatment of stage IV ovarian cancer patients. Price reductions have a major impact on the estimated ICERs. It is recommended to take these findings into account when re-evaluating the reimbursement of bevacizumab in ovarian cancer.
目前，在比利时，贝伐珠单抗被用于卵巢癌患者，这是基于部长和制造商之间的合同，其中包括保密协议。这种报销将在 2018 年重新评估。
通过计算贝伐珠单抗的成本效益，为重新评估报销提供支持：（1）在一线化疗之外；（2）在治疗复发性卵巢癌（铂敏感或铂耐药）中。
根据比利时经济评估指南，为比利时情况开发了一种健康经济学模型。从医疗保健支付者（政府和患者）的角度建立了终生马尔可夫模型，包括直接医疗保健相关成本。结果以每质量调整生命年（QALY）的额外成本表示。计算基于四项国际试验的结果。进行了概率和单向敏感性分析。
一线贝伐珠单抗的增量成本效益比（ICER）平均为 158000 欧元/QALY（GOG-0218 试验）和 443000 欧元/QALY（ICON7 试验）。最有利的情况是基于 GOG-0218 试验的 IV 期亚组（52000 欧元/QALY）。由于亚组发现通常是探索性的，需要确证性研究，因此应谨慎考虑基于该亚组分析的经济评估结果。二线贝伐珠单抗的 ICER 平均为 587000 欧元/QALY（OCEANS 试验）和 172000 欧元/QALY（AURELIA 试验）。敏感性分析表明，结果对贝伐珠单抗的价格最为敏感。
从健康经济学的角度来看，贝伐珠单抗的 ICER 相对较高。最有利的结果是用于治疗 IV 期卵巢癌患者的一线治疗。价格降低对估计的 ICER 有重大影响。建议在重新评估卵巢癌贝伐珠单抗的报销时考虑这些发现。
