Cost effectiveness of bevacizumab plus carboplatin paclitaxel versus carboplatin paclitaxel as front line for advanced ovarian cancer in Thailand

Abstract

Bevacizumab (BEV) combined with standard chemotherapy with carboplatin and paclitaxel (CP) as the front-line treatment for newly diagnosed advanced-stage epithelial ovarian cancer (EOC) is a promising treatment option. In Thailand, combined BEV and CP for patients with high-risk EOC is not yet covered. This study aimed to explore the cost-effectiveness of combined BEV and CP for subgroups with high-risk EOC. Cost-utility analysis was conducted to compare the effectiveness of CP alone versus combined BEV and CP according to the Gynecologic Oncology Group-218 (GOG-218) and the Gynecologic Cancer Intergroup International Collaboration on Ovarian Neoplasms 7 (ICON-7) regimens in patients with EOC. The decision tree model and Markov model were applied, and incremental cost-effectiveness ratios (ICERs) were analyzed. Data on direct medical costs were obtained from cost databases in Thailand. Details about all clinical parameters and direct non-medical costs were obtained from published studies. Utility information was collected by interviewing patient subgroups with high-risk EOC. One-way and probabilistic sensitivity analyses were performed to evaluate parameter uncertainties. Based on the provider and societal perspectives, the ICERs of CP and the GOG-218 regimen were $31,266 and $31,966 per quality adjusted life year (QALY) gained, respectively. Meanwhile, the ICERs of CP and the ICON-7 regimen were $14,331 and $15,003 per QALY gained, respectively. The probabilities of cost-effectiveness for using BEV as the GOG-218 and ICON-7 regimens were 0% and 3%, respectively, based on the willingness-to-pay threshold in Thailand ($4,571 per QALY gained). The median progression-free survival of patients who received combined BEV and CP was the most important parameter leading to more benefit from using BEV. BEV as the GOG-218 or ICON-7 regimen may not be cost-effective for patient subgroups with high-risk EOC in Thailand. However, BEV as the ICON-7 regimen is more likely to be effective.