The Cost-Effectiveness of Bevacizumab for the Treatment of Advanced Ovarian Cancer in Canada

Background: The overall survival (OS) analysis of the icon7 trial demonstrated that frontline ovarian cancer patients with a high risk of progression (stage III suboptimally debulked, and stage III or IV with unresectable disease) benefited from the addition of bevacizumab to standard chemotherapy compared with standard chemotherapy alone. The objective of the present study was to investigate the cost-effectiveness, from a Canadian publicly funded perspective, of adding bevacizumab to frontline treatment of ovarian cancer at high risk of progression. Methods: An area-under-the-curve, Markov-structured model was used to estimate the cost-effectiveness of the treatments. Long-term progression-free survival (PFS) and os were extracted from the icon7 trial (subgroup at high risk of relapse) and extrapolated by parametric time-to-event functions over a time horizon of 10 years. Canadian PFS health state utility values were obtained from the EQ-5D (EuroQoL Group, Rotterdam, Netherlands) questionnaires in the icon7 high-risk patient population. Canadian post-progression utility values were consistent with those for other gynecologic cancers. Cost inputs were informed by public sources. An annual 5% efficacy and cost discount rate was applied. A probabilistic sensitivity analysis and one-way sensitivity analyses were conducted. Results: Ovarian cancer patients at high risk of progression receiving bevacizumab plus standard chemotherapy experienced a mean incremental quality-adjusted life year (QALY) gain of 0.374 years. At an additional cost of $35,901.54, the incremental cost-effectiveness ratio (ICER) for the addition of bevacizumab to standard chemotherapy, relative to standard chemotherapy alone, was $95,942 per QALY. Conclusions: No formal health technology assessment willingness-to-pay threshold exists in Canada. However, at a threshold of $100,000 per QALY, bevacizumab in addition to chemotherapy is a cost-effective alternative for ovarian cancer patients who are at high risk of progression (stage III suboptimally debulked, and stage III or IV with unresectable disease). Using the $100,000 per qaly threshold in a probabilistic sensitivity analysis, it was determined that, compared with standard chemotherapy, the addition of bevacizumab to chemotherapy is cost-effective in 56% of tested scenarios.