The cost-effectiveness of bevacizumab in the first-line treatment of metastatic colorectal cancer in England and Wales

BackgroundBevacizumab is a humanised monoclonal antibody, which has demonstrated significant activity in metastatic colorectal cancer. The aim of this study is to estimate the cost-effectiveness of adding bevacizumab to chemotherapy for patients with untreated metastatic colorectal cancer.MethodsA decision-analytic model was developed to estimate the lifetime costs and benefits of adding bevacizumab to irinotecan plus FU/LV (IFL) or 5-FU/LV alone. Effectiveness outcomes, health utilities and resource use data were derived from recent bevacizumab RCTs and from the literature.ResultsAdding bevacizumab to IFL costs approximately £62,857 per QALY gained. Adding bevacizumab to 5-FU/LV costs approximately £88,436 per QALY gained. The acquisition cost of bevacizumab is a key determinant of its cost-effectiveness. The probability that bevacizumab has a cost-effectiveness ratio that is better than £30,000 per QALY gained is close to zero.ConclusionsGiven high acquisition costs in relation to clinical benefits, bevacizumab is unlikely to represent a cost-effective use of NHS resources.