Meropenem br There are a number of economic analyses
There are a number of economic analyses in which a series of methods were adopted to evaluate bevacizumab as the first-line treatment for advanced nonsquamous NSCLC in several countries . Among them, two cost-effectiveness analyses suggested that bevacizumab combined with carboplatin and paclitaxel was not cost-effective when compared with using only carboplatin and
Conflicts of Interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article.
2212-1099/$36.00 – see front Meropenem 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc
paclitaxel [11,12]. One study reported that bevacizumab added to carboplatin and paclitaxel was not cost-effective when compared with using only cisplatin and pemetrexed . Two studies con-firmed that bevacizumab added to cisplatin and gemcitabine was cost-effective when compared with using only cisplatin and peme-trexed [14,15]. Accordingly, the cost-effectiveness of bevacizumab plus chemotherapy compared with chemotherapy alone remains controversial. Currently, no literature about the cost-effectiveness of bevacizumab based on the trial from China was found. There-fore, we performed a cost-effectiveness analysis of bevacizumab added to chemotherapy compared with chemotherapy alone for patients with advanced nonsquamous NSCLC. Our study on cost-effectiveness was based on the BEYOND trial, which was a muti-center clinical trial in China, and its result was consistent with the practical situation of the Chinese patients .
Materials and Methods
The data and information for this study were derived from the BEYOND trial in China . A Markov model was developed to assess the cost-effectiveness of bevacizumab plus chemotherapy versus chemotherapy alone for the advanced nonsquamous NSCLC.
A Markov decision model of advanced nonsquamous NSCLC was used to evaluate the 10-year clinical and economic outcomes. The time horizon of 10 years can reflect disease progression and allow the survival data from two different treatments to be obtained. The decision model consisted of three mutually exclusive health statuses: progression-free survival (PFS), disease progression (DP), and death (Fig. 1). At the beginning of the model, all patients were in the PFS health status and received one of the two treatments:
2. CP plus bevacizumab (B) (15 mg/kg) IV on day 1 of each cycle until disease progression, or unacceptable toxicity, or death (B+CP).
Each cycle lasted for 3 weeks for both groups. With time, the patients could have remained in the PFS status or moved to the DP status due to disease progression, or they could have died. Patients at the DP status could have retained the DP sta-tus or died. Patients who died from advanced NSCLC or any other cause belonged to the death status, which was the final status.
We built a Markov model to estimate the clinical costs, and life expectancy (LY) and quality-adjusted life year (QALY) gained from the clinical trial. The outcomes of both treat-ments were presented as incremental cost-effectiveness ratios (ICERs).
Collection and Analysis of Clinical Data
The efficacy data originated from a randomized, double-blind, placebo-controlled, multicenter, phase b clinical trial . We used R 2.11.1 (R Foundation, Wien, Austria) to simulate Weibull distributions, which were suitable for the Kaplan-Meier PFS and OS curves from BEYOND trial, and calculated time-dependent transition probabilities for each cycle. The validity of the Markov model can be confirmed by comparing PFS and OS rates obtained from the Markov model based BEYOND trial. The results are presented in Table 1. We calculated the time-dependency transi-tion probability among PFS, DP, and death by using two key parameters of scale (λ) and shape (g), according to the formula as follows: