Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India.
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
JCO Glob Oncol. 2022 Mar;8:e2100355. doi: 10.1200/GO.21.00355.
Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India.
Using a disaggregated societal perspective and lifetime horizon, a Markov model was developed for estimating the costs and health outcomes in a hypothetical cohort of 1,000 patients with advanced and metastatic cervical cancer treated with either standard chemotherapy alone or in combination with bevacizumab. Effectiveness data for each of the treatment regimen were assessed using estimates from Gynecologic Oncology Group 240 trial. Data on disease-specific mortality in metastatic cervical cancer, health system cost, and out-of-pocket expenditure were derived from Indian literature. Multivariable probabilistic sensitivity analysis was undertaken to account for parameter uncertainty.
Over the lifetime of one patient with advanced and metastatic cervical cancer, bevacizumab along with standard chemotherapy results in a gain of 0.275 (0.052-0.469) life-years (LY) and 0.129 (0.032-0.218) quality-adjusted life-years (QALY), at an additional cost of $3,816 US dollars (USD; 2,513-5,571) compared with standard chemotherapy alone. This resulted in an incremental cost of $19,080 USD (7,230-52,434) per LY gained and $34,744 USD (15,782-94,914) per QALY gained with the use of bevacizumab plus standard chemotherapy.
Addition of bevacizumab to the standard chemotherapy is not cost effective for the treatment of advanced and metastatic cervical cancer in India at a threshold of 1-time per-capita gross domestic product.
晚期和转移性宫颈癌患者的预后较差，1 年生存率为 10%-15%。最近，一种抗血管生成的人源化单克隆抗体贝伐珠单抗已被证明能改善这些患者的生存。本研究旨在评估在印度，将贝伐珠单抗与标准化疗联合用于治疗晚期和转移性宫颈癌患者的成本效果。
采用离散的社会视角和终生时间范围，为 1000 名接受标准化疗或联合贝伐珠单抗治疗的晚期和转移性宫颈癌患者建立了一个马尔可夫模型，以估计成本和健康结果。每种治疗方案的有效性数据均使用 Gynecologic Oncology Group 240 试验的估计值进行评估。转移性宫颈癌的疾病特异性死亡率、卫生系统成本和自付费用的数据均来自印度文献。进行了多变量概率敏感性分析，以考虑参数不确定性。
在一名晚期和转移性宫颈癌患者的一生中，贝伐珠单抗联合标准化疗可增加 0.275（0.052-0.469）个生命年（LY）和 0.129（0.032-0.218）个质量调整生命年（QALY），而成本增加 3816 美元（2513-5571 美元）。与单独使用标准化疗相比，这导致每获得一个 LY 的增量成本为 19080 美元（7230-52434 美元），每获得一个 QALY 的增量成本为 34744 美元（15782-94914 美元）。
在印度，将贝伐珠单抗加入标准化疗治疗晚期和转移性宫颈癌的成本不划算，达到人均国内生产总值的一次。
