Cost-effectiveness of a bevacizumab biosimilar for the treatment of recurrent, platinum-sensitive ovarian cancer in the United States

OBJECTIVE: While bevacizumab may benefit patients with recurrent, platinum-sensitive epithelial ovarian cancer (EOC), its use is inconsistent. In part, this may be due to its cost. To assess whether a lower-cost biosimilar (bevacizumab-awwb) could be cost-effective, we evaluated the cost-effectiveness of bevacizumab-awwb in combination with platinum-based chemotherapy versus chemotherapy alone in this setting. METHODS: We evaluated the incremental cost-effectiveness of 1) bevacizumab-awwb and 2) brand-name bevacizumab, when used with standard, platinum-based chemotherapy. Lifetime costs and median overall survival were compared to those with chemotherapy alone. Treatment regimens and survival estimates were based on the GOG-0213 trial. Costs were obtained from Centers for Medicare & Medicaid Services data. We assumed brand-name bevacizumab and bevacizumab-awwb, the lowest-price biosimilar, were differentiated by cost only ($74 vs $24 per 10 mg). In threshold analysis, we identified bevacizumab and biosimilar costs that would achieve cost-effectiveness at a willingness-to-pay (WTP) threshold of $150,000 per life-year gained (LYG). RESULTS: Total costs of treatment with platinum-based chemotherapy alone were $198,440; median survival was 3.11 years. Adding brand-name bevacizumab increased total costs and median survival ($362,206, 3.52 years), resulting in an ICER of $399,400/LYG. Substituting bevacizumab-awwb for brand-name bevacizumab reduced total costs and the ICER ($252,512, ICER = $131,900/LYG vs. chemotherapy alone). For bevacizumab (or a biosimilar) to be cost-effective within the above-specified WTP threshold, its price would need to be under $27/10 mg; bevacizumab-awwb is within this range. CONCLUSION: Bevacizumab has the potential to be cost-effective in treating recurrent, platinum-sensitive EOC, provided its cost is similar to current, lowest-cost biosimilars.