Adding Avastin (bevacizumab) to a chemotherapy regimen with pemetrexed/cisplatin may not be a cost-effective choice to treat malignant pleural mesothelioma (MPM), according to a new Chinese study.
The study, “Cost-effectiveness analysis of additional bevacizumab to pemetrexed plus cisplatin for malignant pleural mesothelioma based on the MAPS trial,” appeared in the journal Lung Cancer.
China’s low incidence of MPM justifies a price discount for patients, say researchers. They also called for assistance programs and medical insurance to make Avastin more affordable.
Pemetrexed/cisplatin is the gold standard first-line treatment for patients with MPM.
A previous Phase 3 trial, called MAPS (NCT00651456), showed that patients with unresectable MPM who received Avastin in addition to pemetrexed/cisplatin survived 18.8 months, compared to 16.1 months for those treated only with pemetrexed/cisplatin only, with no negative impact on quality of life.
However, Avastin is a very expensive therapy.
“Although the clinical outcomes can be viewed as major progress in the treatment of MPM, median progression-free survival (PFS) up to 9.2 months means that the duration of bevacizumab use in first-line and maintenance settings will dramatically increase the costs of treatment,” researchers wrote. “Therefore, it is very important to consider the health economics value of this new treatment option, especially in developing countries such as China, in which bevacizumab needs to be paid for by the patient.”
To estimate the cost-effectiveness of adding Avastin to pemetrexed/cisplatin as a treatment for MPM, researchers analyzed data from the MAPS trial, including the disease states of progression-free survival, progressive disease, and mortality.
They also assessed the total therapy costs, and health outcomes were converted into quality-adjusted life year (QALY, a measure of how medical intervention interfere with a patient’s quality of life).
Researchers estimated that adding Avastin to pemetrexed/cisplatin increased costs by $81,446.69, with a gain of 0.112 QALYs. This resulted in an incremental cost-effectiveness ratio (ICER) of $727,202 per QALY.
According to the authors, ICER values exceeded the commonly accepted willingness-to-pay threshold of three times China’s per-capita GDP, or $23,970.00 per QALY.
“Despite the promising results of the MAPS trial, our health economics analysis demonstrated that the addition of bevacizumab to the standard chemotherapy throughout the primary plus maintenance therapy period for unresectable MPM was not a cost-effective alternative from the perspective of a Chinese payer,” researchers wrote.