Survival and lifetime costs associated with first-line bevacizumab in older patients with metastatic colorectal cancer

Publication Type:

Journal Article

Source:

European Journal of Cancer, Volume 49, p.S328-S328 (2013)

Keywords:

2013, March 2014, Public Health Sciences Division, Public Health Sciences Division March 2014 2014Q1 CCSG

Abstract:

Background: The relative costs and benefits of newer agents such as bevacizumab (Bev) in older patients with metastatic colorectal cancer (mCRC) are not well understood. The objective of this study was to investigate clinical effectiveness and incremental lifetime costs associated with first-line bevacizumab in older mCRC treated in community settings, from the United States government healthcare payer (Medicare) perspective. Material and Methods: Patients diagnosed with mCRC in 2004–2007 were identified from SEER-Medicare, a database which links Medicare claims with a population-based cancer registry representing  25% of the United States population (SEER). Patients were stratified by first-line treatment strategy (no chemotherapy (CTx), CTx alone, CTx + Bev). Median and mean survival times were determined for each cohort by Kaplan–Meier method. A Cox proportional hazards model was used to determine the relative benefit of Bev, controlling for important demographic and treatment characteristics. Mean lifetime costs were calculated for each cohort using Medicare claims for all services rendered between diagnosis and end of follow up, adjusting for death and censoring. Results: 4,414 patients (mean age 77.3) were identified, of whom 15% received first-line Bev. Mean duration of first-line Bev was 6.9 months. Receipt of CTx + Bev was associated with an improved survival compared with CTx alone in the Cox model (HR 0.80, 95% 0.71–0.89). Median and mean survival were greatest in patients treated with CTx + Bev relative to CTx alone or no CTx (19.4 (28.0) vs. 15.1 (22.9) vs. 5.7 (14.1) months, p < 0.001). Mean lifetime costs were also greatest in the CTx + Bev group compared with CTx or no CTx (mean per patient cost $143,284, $111,280, and $55,504 respectively). Compared with CTx alone, CTx + Bev was associated with a 5.1 month increase in mean survival and $32,004 increase in mean lifetime treatment costs; the relative cost of Bev treatment was $75,303 per life year gained. Conclusions: The relative benefit of Bev in older Medicare enrollees treated in real world clinical settings in the United States is comparable to the benefit observed in randomized clinical trials but is associated with an incremental cost of $75,303 per life year gained.

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