A cost-utility analysis of NRG Oncology/Gynecologic Oncology Group Protocol 218: Incorporating prospectively collected quality-of-life scores in an economic model of treatment of ovarian cancer

- Bevacizumab is not cost effective in the adjuvant and maintenance treatment of advanced ovarian cancer.
- Prospective collection of cost and quality of life data is critical to a well-executed cost-utility analysis.

ObjectiveTo estimate quality-of-life (QOL)-adjusted cost-utility with addition of bevacizumab (B) to intravenous paclitaxel/carboplatin (PC) for primary treatment of advanced-stage epithelial ovarian cancer.MethodsA modified Markov state transition model of 3 regimens evaluated in GOG 218 (PC, PC + concurrent B [PCB], and PCB + maintenance B [PCB + B]) was populated by prospectively collected survival, adverse event, and QOL data from GOG 218. Progression-free survival (PFS) and overall survival (OS) were modeled using primary event data. Costs of grade 4 hypertension, grade 3-5 bowel events, and growth factor support were incorporated. QOL scores were converted to utilities and incorporated into the model. Monte Carlo probabilistic sensitivity analysis was performed to account for uncertainty in estimates.ResultsPC was the least expensive ($4044) and least effective (mean 1.1 quality-adjusted progression-free years [QA-PFY]) regimen. PCB ($43,703 and 1.13 QA-PFY) was dominated by a combination of PC and PCB + B. PCB + B ($122,700 and 1.25 QA-PFY) was the most expensive regimen with an incremental cost-effectiveness ratio of $792,380/QA-PFY compared to PC. In a model not incorporating QOL, the incremental cost-effectiveness ratio (ICER) of PCB + B was $632,571/PFY compared to PC.ConclusionsIn this cost-utility model, incorporation of QOL into an analysis of GOG 218 led to less favorable ICER (by >$150,000/QA-PFY) in regimens containing B compared with those that do not include B. Continued investigation of populations with ovarian cancer in whom the efficacy of treatment with bevacizumab is expected to be increased (or in whom QOL is expected to increase with use) is critical.