Advice
Evidence review: economic issues
Cost effectiveness
No studies on the cost effectiveness of bevacizumab 7.5 mg/kg for advanced ovarian cancer were identified.
Cost
MIMS (July 2013) lists the price for bevacizumab at 25 mg/ml solution for intravenous infusion in the following vials:
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bevacizumab 100 mg/4 ml: £242.66
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bevacizumab 400 mg/16 ml: £924.40.
For women whose weight is in the range of 53.4 kg to 66.6 kg, the 'drug-only' cost of bevacizumab at a dose of 7.5 mg/kg would be £1167.06 per cycle. This assumes that a 16 ml vial can treat a woman who weighs up to 53.3 kg, but for those weighing between 53.4 kg and 66.6 kg a 16 ml and a 4 ml vial would be needed in combination (assuming wastage). The suggested regimen would be bevacizumab in combination with paclitaxel and carboplatin for 6 cycles and then on its own for up to an additional 12 cycles or until disease progression (up to 18 cycles in total). This would equate to between £7002.36 (for the first 6 cycles) and £21,007.08 (for the first 6 cycles plus an additional 12 cycles). This does not include the cost of administration by intravenous infusion in hospital. This additional cost would be greater during the extended treatment phase when standard chemotherapy has finished.
Current drug usage
Bevacizumab is currently available in England through the national cancer drugs fund list at a dose of 7.5 mg/kg for first-line treatment of advanced (stage IIIc/IV) ovarian cancer, suboptimally debulked either at primary or delayed primary (interval) surgery (including peritoneal and fallopian tube cancer) or unsuitable for debulking surgery. The latest figures from NHS England show that 116 notifications were received in the first quarter of 2013/14 for use of bevacizumab 7.5 mg/kg. Each notification represents 1 patient being registered to start a full course of treatment. The definition of advanced ovarian cancer for the indication on the national cancer drugs fund list includes people with stage IIIC/IV ovarian cancer. This differs from the definition of advanced ovarian cancer in the NICE technology appraisal guidance on bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer, which defines advanced ovarian cancer as those with stage IIIB, IIIC and IV disease.