Survival and Lifetime Costs Associated With First-Line Bevacizumab Use in Older Patients With Metastatic Colorectal Cancer

Shankaran, Veena; Mummy, David; Koepl, Lisel; Bansal, Aasthaa; Mirick, Dana K.; Yu, Elaine; Morlock, Rob; Ogale, Sarika; Ramsey, Scott D.

doi:10.1634/theoncologist.2013-0209

Cited by 20 publications

(7 citation statements)

References 42 publications

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“…Although our results indicate that targeted therapies may have reduced early mortality, treatment with targeted therapy was not associated with a lower risk of death at 36 months. These findings are consistent with existing data, the improvement in OS by targeted therapies not being significant in many studies, even in younger populations . Nevertheless, a relevant evaluation of the effectiveness of cancer treatment in older adults should be based on other end points such as progression‐free survival, quality of life, and maintenance of independence .…”

Section: Discussionsupporting

confidence: 88%

“…These findings are consistent with existing data, the improvement in OS by targeted therapies not being significant in many studies, even in younger populations. 23,[25][26][27][28][29] Nevertheless, a relevant evaluation of the effectiveness of cancer treatment in older adults should be based on other end points such as progression-free survival, quality of life, and maintenance of independence. 20 Data regarding these end points are currently lacking regarding the comparison of treatment with or without targeted therapy in real-life settings.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Gouverneur

Bezin

Jové

et al. 2019

J American Geriatrics Society

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OBJECTIVES Metastatic colorectal cancer (mCRC) is increasingly treated with targeted therapies, but little is known about real‐life mCRC treatment in older adults. The aims were to describe the real‐life first‐line treatment modalities in older adult mCRC patients, to identify factors associated with treatment modalities, and to evaluate survival with regard to treatment modalities. PATIENTS AND METHODS A cohort of mCRC patients aged 65 years and older at diagnosis was identified between 2009 and 2013 using French national healthcare insurance system claims data. Treatment modalities were: treatment with one or more anticancer medication vs best supportive care and, among treated patients, treatment with targeted therapy vs conventional chemotherapy alone. Multivariate logistic regression was used to identify factors associated with treatment by anticancer medication and by targeted therapy. Cox proportional hazards models were used to assess the independent effect of treatment modalities on overall survival while adjusting for baseline covariates identified with logistic regression. RESULTS A total of 503 patients were included with a median age of 78 years (54% were men). Of these, 299 (59%) were treated with anticancer medications. Among treated patients, 131 (44%) received targeted therapy. In multivariate analysis, age 75 years or older, renal failure, malnutrition, and five or more concomitant medications were associated with a lower likelihood of treatment with anticancer medications. Among treated patients, age 75 years or older, history of cancer, lymph node metastases, and a single metastatic site were associated with a lower likelihood of treatment with targeted therapy. Multivariate Cox proportional hazards models found that treatment with any anticancer medication tended to be associated with a lower risk of death; treatment with targeted therapy was not significantly associated. CONCLUSION A more appropriate prescription of anticancer medications in the older adult will require the definition of more explicit criteria to avoid undertreatment. The real benefit of targeted therapies vs conventional chemotherapy alone needs to be confirmed in this population. J Am Geriatr Soc 67:913–919, 2019.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Gouverneur

Bezin

Jové

et al. 2019

J American Geriatrics Society

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“…A retrospective database analysis found that adding bevacizumab to chemotherapy in the first-line setting cost $75,303/LY. 17 The lower ICER in the retrospective study, compared to the Markov model, may be due to the greater bevacizumab efficacy seen in the retrospective study. 3 …”

Section: Resultsmentioning

confidence: 94%

Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies

Goldstein

Zeichner

Bartnik

et al. 2016

Clinical Colorectal Cancer

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Aim To evaluate, from a US payer perspective, the cost-effectiveness of treatment strategies for metastatic colorectal cancer (mCRC). Methods We performed a systematic review of published cost-effectiveness analyses of treatment strategies for mCRC with pre-specified search criteria. Results We identified 14 papers that fulfilled our search criteria and revealed varying levels of value amongst current treatment strategies. Older agents such as 5FU, irinotecan, and oxaliplatin provide high value treatments. More modern agents targeting the EGFR or VEGF pathways, such as bevacizumab, cetuximab and panitumumab do not appear to be cost effective treatments at their current costs. The analytical methods used within the papers varied widely, and likely plays a significant role in the heterogeneity in incremental cost effectiveness ratios. Conclusions The cost-effectiveness of current treatment strategies for mCRC is highly variable. Drugs recently approved by the Federal Drug Administration (FDA) for mCRC are not cost-effective, and this is primarily driven by high drug costs.

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“…Observational studies of bevacizumab with irinotecan have also reported mixed results; Ruiz-Millo and colleagues reported increased costs of €12,700 per patient (CAD$17,300), with no significant improvement in progression-free survival in a small hospital setting, 35 while Shankaran and colleagues reported an ICER of US$75,303 (CAD$98,700) using linked SEER-Medicare data. 36…”

Section: Discussionmentioning

confidence: 99%

Real-World Cost-Effectiveness of Bevacizumab With First-Line Combination Chemotherapy in Patients With Metastatic Colorectal Cancer: Population-Based Retrospective Cohort Studies in Three Canadian Provinces

Pataky

Beca

Tran

et al. 2021

MDM Policy & Practice

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Background. Real-world evidence can be a valuable tool when clinical trial data are incomplete or uncertain. Bevacizumab was adopted as first-line therapy for metastatic colorectal cancer (mCRC) based on significant survival improvements in initial clinical trials; however, survival benefit diminished in subsequent analyses. Consequently, there is uncertainty surrounding the cost-effectiveness of bevacizumab therapy achieved in practice. Objective. To assess real-world cost-effectiveness of first-line bevacizumab with irinotecan-based chemotherapy versus irinotecan-based chemotherapy alone for mCRC in British Columbia (BC), Saskatchewan, and Ontario, Canada. Methods. Using provincial cancer registries and linked administrative databases, we identified mCRC patients who initiated publicly funded irinotecan-based chemotherapy, with or without bevacizumab, in 2000 to 2015. We compared bevacizumab-treated patients to historical controls (treated before bevacizumab funding) and contemporaneous controls (receiving chemotherapy without bevacizumab), using inverse-probability-of-treatment weighting with propensity scores to balance baseline covariates. We calculated incremental cost-effectiveness ratios (ICER) using 5-year cost and survival adjusted for censoring, with bootstrapping to characterize uncertainty. We also conducted one-way sensitivity analysis for key drivers of cost-effectiveness. Results. The cohorts included 12,112 (Ontario), 1,161 (Saskatchewan), and 2,977 (BC) patients. Bevacizumab significantly increased treatment costs, with mean ICERs between $78,000 and $84,000/LYG (life-year gained) in the contemporaneous comparisons and $75,000 and $101,000/LYG in the historical comparisons. Reducing the cost of bevacizumab by 50% brought ICERs in all comparisons below $61,000/LYG. Limitations. Residual confounding in observational data may bias results, while the use of original list prices overestimates current bevacizumab cost. Conclusion. The addition of bevacizumab to irinotecan-based chemotherapy extended survival for mCRC patients but at significant cost. At original list prices bevacizumab can only be considered cost-effective with certainty at a willingness-to-pay threshold over $100,000/LYG, but price reductions or discounts have a significant impact on cost-effectiveness.

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Survival and Lifetime Costs Associated With First-Line Bevacizumab Use in Older Patients With Metastatic Colorectal Cancer

Cited by 20 publications

References 42 publications

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life

Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies

Real-World Cost-Effectiveness of Bevacizumab With First-Line Combination Chemotherapy in Patients With Metastatic Colorectal Cancer: Population-Based Retrospective Cohort Studies in Three Canadian Provinces

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