45P - Cost-effectiveness analysis of VEGF-A testing to predict response to bevacizumab (BEV) as a component of neo-adjuvant therapy of early HER-2 negativ...

Date 07 May 2015
Event IMPAKT 2015
Session Welcome reception and Poster Walk
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Early Stage
Bioethics, Legal, and Economic Issues
Translational Research
Presenter Patricia Blank
Citation Annals of Oncology (2015) 26 (suppl_3): 15-24. 10.1093/annonc/mdv117
Authors P.R. Blank1, S. Loibl2, B.K. Linderholm3, S. Caramuta3, V. Nekljudova2, T.D. Szucs1, J. Van Stiphout1, Z. Ademi1, G. von Minckwitz2, M. Schwenkglenks1
  • 1European Center Of Pharmaceutical Medicine (ecpm), University of Basel Institute of Pharmaceutical Medicine, 4056 - Basel/CH
  • 2Medicine And Research, German Breast Group, GBG Forschungs GmbH, 63263 - Neu-Isenburg/DE
  • 3Department Of Oncology/pathology,, Karolinska University Hospital and Karolinska Institute-Huddinge, 141 86 - Stockholm/SE

Abstract

Body

Background: The effect of BEV to neo-adjuvant chemotherapy is modest in unselected HER2-negative (HER2-) breast cancer (BC) patients. VEGF-A has been suggested as a predictor for response to neoadjuvant BEV. We estimated the cost-effectiveness of using VEGF-A testing and corresponding treatment strategies in the neoadjuvant treatment of hormone receptor (estrogen or progesterone) positive (HR+), HER2- BC.

Methods: Using a life-long Markov state transition model, we determined the health economic impact and incremental cost-effectiveness ration (ICER) of VEGF-A guided use of BEV therapy. Six alternative strategies were compared (four different VEGF-A cut-off values; two implying the use of BEV in no or all patients. Overall and metastasis-free survival information was derived from GeparQuinto (n = 830) trial (EudraCT No: 2006-005834-19). Effectiveness was assessed as quality-adjusted life-years (QALYs). Costs (in EUR, year 2013) were assessed from a German third-party payer perspective.

Results: Lifetime costs per patient ranged from EUR 37'042 (reference strategy; no BEV) to EUR 78'367 (BEV to all). No BEV therapy yielded 14.031 QALYs per patient. The VEGF-A guided strategies achieved between 14.220 (cut-off 450 pg/mL) and 14.235 (cut-off 339 pg/mL) QALYs. In comparison with no BEV therapy, the most preferable strategy (cut-off 450 pg/mL) yielded additional costs of 11'191 EUR and 0.189 QALYs per patient (ICER 59'161 EUR/QALY) (Tab 1, only undominated strategies shown). Results remained robust in deterministic sensitivity analyses.

Conclusion: Our study suggests that VEGF-A testing could be sensibly used to guide the neo-adjuvant administration of BEV in HR+ HER2- BC. Compared to not using BEV, the use of a cut-off value of 450 pg/mL might be cost-effective in Germany. Tab 1

Cost (EUR) Incremental Cost (EUR) QALY Incremental effect (QALY) ICER (EUR/QALY)
No test, no BEV 37'042 14,031
VEGF-A 450 48'233 11'191 14,220 0,189 59'161 (vs. reference)
VEGF-A 400 50380 1'338 14,230 0,199 227'344 (vs. VEGF-A 450)
VEGF-A 339 54'061 17'019 14,235 0,204 673'769 (vs. VEGF-A 400)

Disclosure: All authors received funding from the European Commission 7th Framework Programme, Call FP7-HEALTH-2011-two-stage, under grant agreement No 278659 (RESPONSIFY).