Bevacizumab in recurrent, persistent, or advanced stage carcinoma of the cervix: Is it cost-effective?

•Bevacizumab plus paclitaxel and cisplatin in advanced, recurrent or persistent cervix cancer has an ICER/QALY of $155K.•Bevacizumab use in this setting is more cost-effective than in any other gynecologic malignancy to date.•Marginally discounting the cost of bevacizumab by > 37.5% results in an ICER/QALY of $100K.

ObjectiveEvaluate the cost-effectiveness of incorporating bevacizumab into the treatment regimen for recurrent, persistent, or advanced stage carcinoma of the cervix following publication of a recent phase III trial that demonstrated an overall survival (OS) benefit with the addition of bevacizumab.MethodsA cost-effectiveness decision model was constructed using recently published results from a Gynecologic Oncology Group phase III study, comparing a standard chemotherapy regimen (Chemo) to the experimental regimen (Chemo + Bev) consisting of the standard regimen + bevacizumab. Costs and adverse events were incorporated and sensitivity analyses assessed model uncertainties.ResultsThe cost of Chemo + Bev was $53,784 compared to $5,688 for the Chemo arm. The 3.7 month OS advantage with Chemo + Bev came at an incremental cost-effectiveness ratio (ICER) of $155K per quality-adjusted life year (QALY). Chemo + Bev becomes cost-effective with an ICER ≤ $100K in sensitivity analysis when the cost of bevacizumab is discounted > 37.5% or the dose is reduced from 15 to 7.5 mg/kg, an effective dose in ovarian cancer.ConclusionsWith an ICER of $155K/QALY, the addition of bevacizumab to standard chemotherapy approaches common cost-effectiveness standards. Moderately discounting the cost of bevacizumab or using a smaller dose significantly alters its affordability.