Abstract
Background
Bevacizumab has been extensively investigated in combination with various standard
chemotherapies in the treatment of metastatic colorectal cancer (mCRC). However, a
comparison to irinotecan + infusional 5-fluorouracil/leucovorin (FOLFIRI) is lacking.
Objective
To explore clinical effectiveness and cost-effectiveness of adding bevacizumab to
a regimen of FOLFIRI for the first-line treatment of mCRC in the Republic of Korea
by conducting an indirect treatment comparison.
Methods
A health-economic model was developed to investigate the possible health outcomes
(life-years gained [LYG]), direct costs, and incremental cost-effectiveness ratio
(ICER) of adding bevacizumab to a FOLFIRI regimen. Data on progression-free and overall
survival were derived from randomized clinical trials and were used in the indirect
treatment comparison. The annual discount rate for costs and outcomes was 5%. A lifetime
horizon of 8 years was used. Sensitivity analyses were carried out on all pivotal
model assumptions.
Results
Incremental mean overall survival among patients treated with bevacizumab + FOLFIRI
varied between 8.6 and 15.7 months compared with patients treated with FOLFIRI alone.
The deterministic base-case result was 1.177 LYG. The discounted ICERs ranged from
μ31.8 to μ39.5 million/LYG, with the base-case result being μ34.5 million/LYG. Treatment
effect had the most impact on the outcomes in this model.
Conclusions
Although there is no formal threshold for ICER per LYG in Korea, funding may be considered
for bevacizumab + FOLFIRI, particularly if the severity and end-of-life nature of
mCRC is taken into account.
Key words
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Article info
Publication history
Published online: June 04, 2012
Accepted:
May 9,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
