Survival and Lifetime Costs Associated With First-Line Bevacizumab Use in Older Patients With Metastatic Colorectal Cancer
Open Access
- 1 August 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 19 (8), 892-899
- https://doi.org/10.1634/theoncologist.2013-0209
Abstract
Introduction.: The objective of this study was to investigate clinical effectiveness and incremental lifetime costs associated with first-line bevacizumab in older patients with metastatic colorectal cancer (mCRC). Methods.: Patients diagnosed with mCRC in 2004–2007 were identified from the Surveillance, Epidemiology, and End Results-Medicare database and stratified by first-line treatment (no chemotherapy [CTx], CTx alone, CTx plus bevacizumab). The impact of first-line bevacizumab on survival was investigated using a propensity score adjusted multivariate Cox proportional hazards model. Mean lifetime costs for each cohort were calculated using Medicare claims for all services rendered between diagnosis and end of follow-up, adjusting for death and censoring. Results.: A total of 4,414 patients (mean age: 77.3 years) were identified, of whom 15% received first-line bevacizumab. Among first-line-treated patients, bevacizumab receipt was associated with improved overall survival (hazard ratio: 0.85 [95% confidence interval: 0.75–0.97]; p = .013), and this benefit was limited to patients who received >1 month of bevacizumab therapy. Median and mean survival were greatest in patients treated with CTx plus bevacizumab relative to CTx alone (CTx plus bevacizumab median 19.4 months [mean 28.0 months] vs. CTx alone median 15.1 months [mean 22.9 months]; p < .001), as were mean lifetime costs (mean per patient cost $143,284 vs. $111,280). Compared with CTx alone, CTx plus bevacizumab was associated with a 5.1-month increase in mean survival and a $32,004 increase in mean lifetime treatment costs, with an incremental cost of $75,303 per life-year gained. Conclusion.: Bevacizumab use is associated with longer survival than CTx alone in older patients treated in real-world clinical settings, at an incremental cost of $75,303 per life-year gained.Keywords
Funding Information
- Genentech, Inc.
This publication has 45 references indexed in Scilit:
- Effectiveness of Bevacizumab With First-Line Combination Chemotherapy for Medicare Patients With Stage IV Colorectal CancerJournal of Clinical Oncology, 2012
- Lifetime economic burden of prostate cancerBMC Health Services Research, 2011
- Bending the Cost Curve in Cancer CareThe New England Journal of Medicine, 2011
- Projections of the Cost of Cancer Care in the United States: 2010-2020JNCI Journal of the National Cancer Institute, 2011
- Improved Survival in Metastatic Colorectal Cancer Is Associated With Adoption of Hepatic Resection and Improved ChemotherapyJournal of Clinical Oncology, 2009
- Cost implications of new treatments for advanced colorectal cancerCancer, 2009
- Safety and Efficacy of Oxaliplatin and Fluoropyrimidine Regimens With or Without Bevacizumab As First-Line Treatment of Metastatic Colorectal Cancer: Results of the TREE StudyJournal of Clinical Oncology, 2008
- Evaluation of Trends in the Cost of Initial Cancer TreatmentJNCI Journal of the National Cancer Institute, 2008
- Bevacizumab in Combination With Oxaliplatin-Based Chemotherapy As First-Line Therapy in Metastatic Colorectal Cancer: A Randomized Phase III StudyJournal of Clinical Oncology, 2008
- A Randomized Controlled Trial of Fluorouracil Plus Leucovorin, Irinotecan, and Oxaliplatin Combinations in Patients With Previously Untreated Metastatic Colorectal CancerJournal of Clinical Oncology, 2004