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Adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer: A cost-effectiveness analysis of the AURELIA trial
Abstracts / Gynecologic Oncology 141 (2016) 2–208
doi:10.1016/j.ygyno.2016.04.114
83 - Featured Poster Session Evaluating the trend of minimally invasive surgery for cervical cancer: An NSQIP database analysis J.B. Szender, P.C. Mayor, K.O. Odunsi, S.B. Lele, E. Zsiros, P.J. Frederick. Roswell Park Cancer Institute, Buffalo, NY, USA
DP
Objectives: Determine the impact of more minimally invasive surgery (MIS) on postoperative outcomes in cervical cancer patients. Methods: We evaluated the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients undergoing elective surgery for cervical cancer. Patients were categorized as undergoing hysterectomy through an MIS approach (CPT code 58500-58599) or laparotomy. Analyses were also stratified by year of surgery. Postoperative outcomes including venous thromboembolism (VTE), surgical site infection (SSI), pneumonia, urinary tract infection (UTI), sepsis, return to the operating room (ROR), and death were recorded. Outcomes were compared using χ2 test of independence or Mann-Whitney U test, as appropriate. The Mantel-Haenszel method was used for adjustments. The threshold of significance was P b .05. Results: We identified 1,320 patients with complete data who underwent elective hysterectomy for cervical cancer; 608 were minimally invasive surgeries. The frequency of MIS increased from 18.2% in 2007 to 54.9% in 2013. Operative times did not differ between open and MIS approaches (208 min vs 206 min, P = .6425); however, length of stay for MIS patients was significantly shorter (1.7 vs 5.0 days, P b .0001). MIS patients had a 56% lower risk of postoperative complications compared with laparotomy patients (RR 0.44, 95% CI 0.35–0.55), the relative risk of SSI was 0.33 (95% CI 0.18–0.59). Risk of pneumonia (RR 0.29, 95% CI 0.06–1.37) and UTI (RR: 0.92, 95% CI 0.61– 1.40) did not differ between approaches. There were also no significant differences in risk of VTE (P = .09), ROR (P = .33), or death (P = .91). Complications tended to be more common in MIS before 2010 (127.7 per 1,000 MIS surgeries vs 69.2 per 1,000 open surgeries), but starting in 2010, the risk of complications was more than 60% lower for MIS patients (RR 0.37, 95% CI 0.29–0.48). Conclusions: Treatment of cervical cancer with MIS significantly reduces the risk of postoperative complications and length of hospitalization. Although there was no difference in rate of perioperative deaths, improved patient outcomes without a significant change in operative time may lead to cost savings to the health system. MIS should be considered for patients undergoing surgical treatment of cervical cancer.
improved progression-free survival (PFS) in the bevacizumab + chemotherapy arm compared with chemotherapy alone. The goal of this study was to evaluate the cost-effectiveness of adding bevacizumab to single-agent chemotherapy in the treatment of platinum-resistant recurrent ovarian cancer. Methods: A decision tree model was constructed to evaluate the cost-effectiveness of adding bevacizumab to standard treatment with single-agent chemotherapy based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and PFS were modeled over a 15-month period. All model inputs were extracted from published peer-reviewed literature and public sources. Costs and QALYs were discounted at an annual 3% rate. All costs were adjusted to 2015 US dollars. Incremental cost-effectiveness ratios (ICERs) per QALY gained and ICERs per progression-free life year saved (PF-LYS) were calculated. Probabilistic sensitivity analyses were performed to evaluate the robustness of results. Results: The ICER associated with bevacizumab + chemotherapy is $285,624 per QALY gained and $151,059 per PF-LYS. At a willingnessto-pay (WTP) threshold of $50,000/QALY, adding bevacizumab to single-agent chemotherapy is not cost-effective in this patient population. Even at a WTP threshold of $100,000/QALY, bevacizumab + chemotherapy is not cost-effective. These findings are robust to deterministic and probabilistic sensitivity analyses. Conclusions: Despite gains in QALY and PFS, the addition of bevacizumab to single-agent chemotherapy for treatment of platinum-resistant recurrent ovarian cancer is not cost-effective at a WTP threshold of $50,000/QALY. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this population of patients.
OF
Conclusions: The overall 5-year survival for RoRHBPLND for treatment of clinical stage I cervical is 87.5%. There was no difference in 5-year survival among RoRHBPLND, LRHBPLND, and ORHBPLND.
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doi:10.1016/j.ygyno.2016.04.116
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RR
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85 - Featured Poster Session A cost-effectiveness analysis of the AURELIA trial: Bevacizumab and paclitaxel offer a promising clinical and economic combination for platinum-resistant ovarian cancer J.L. Lesnocka, C.A. Hamiltonb, K.M. Darcyc, L.J. Havrileskyd, T.C. Krivake, G.L. Maxwellf, W.J. Loweryb. aMid Atlantic Gynecologic Oncology of Mon General Hospital, Morgantown, WV, USA, bMurtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA, cGynecologic Cancer Center of Excellence, Annandale, VA, USA, dDuke University Medical Center, Durham, NC, USA, eWestern Pennsylvania Hospital, Pittsburgh, PA, USA, fInova Fairfax Hospital, Falls Church, VA, USA
UN
doi:10.1016/j.ygyno.2016.04.115
84 - Featured Poster Session Adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer: A cost-effectiveness analysis of the AURELIA trial W.Z. Wysham, E.M. Schaffer, T.M. Coles, D.R. Roque, S.B. Wheeler, K.H. Kim. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Objectives: AURELIA was a randomized phase III trial of adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer that demonstrated
Objectives: To evaluate the cost-effectiveness of bevacizumab use in platinum resistant-ovarian cancer (PR-OC). Methods: Decision-analysis models were constructed to evaluate each of the treatment arms of the AURELIA trial. Arm 1 of each model included the standard chemotherapy regimen: liposomal doxorubicin, topotecan, or paclitaxel. Arm 2 included the standard regimen with the addition of bevacizumab (doxorubicin + bevacizumab, topotecan + bevacizumab, or paclitaxel + bevacizumab). Overall survival (OS), rates of adverse events (AEs), and rates of salvage bevacizumab in each arm were obtained from the AURELIA trial. Table 1 lists these rates as well as costs for each treatment arm, based on average number of chemotherapy cycles. Treatment strategies were compared using an incremental cost-effectiveness ratio (ICER) and a standard willingness to pay threshold of $100,000/year of life saved (YLS). Sensitivity analyses were performed to account for uncertainty in assumptions. Results: The paclitaxel arm with a median OS of 13.2 months was the least costly arm with an average cost of $10,386. The
doi:10.1016/j.ygyno.2016.04.114
83 - Featured Poster Session Evaluating the trend of minimally invasive surgery for cervical cancer: An NSQIP database analysis J.B. Szender, P.C. Mayor, K.O. Odunsi, S.B. Lele, E. Zsiros, P.J. Frederick. Roswell Park Cancer Institute, Buffalo, NY, USA
DP
Objectives: Determine the impact of more minimally invasive surgery (MIS) on postoperative outcomes in cervical cancer patients. Methods: We evaluated the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients undergoing elective surgery for cervical cancer. Patients were categorized as undergoing hysterectomy through an MIS approach (CPT code 58500-58599) or laparotomy. Analyses were also stratified by year of surgery. Postoperative outcomes including venous thromboembolism (VTE), surgical site infection (SSI), pneumonia, urinary tract infection (UTI), sepsis, return to the operating room (ROR), and death were recorded. Outcomes were compared using χ2 test of independence or Mann-Whitney U test, as appropriate. The Mantel-Haenszel method was used for adjustments. The threshold of significance was P b .05. Results: We identified 1,320 patients with complete data who underwent elective hysterectomy for cervical cancer; 608 were minimally invasive surgeries. The frequency of MIS increased from 18.2% in 2007 to 54.9% in 2013. Operative times did not differ between open and MIS approaches (208 min vs 206 min, P = .6425); however, length of stay for MIS patients was significantly shorter (1.7 vs 5.0 days, P b .0001). MIS patients had a 56% lower risk of postoperative complications compared with laparotomy patients (RR 0.44, 95% CI 0.35–0.55), the relative risk of SSI was 0.33 (95% CI 0.18–0.59). Risk of pneumonia (RR 0.29, 95% CI 0.06–1.37) and UTI (RR: 0.92, 95% CI 0.61– 1.40) did not differ between approaches. There were also no significant differences in risk of VTE (P = .09), ROR (P = .33), or death (P = .91). Complications tended to be more common in MIS before 2010 (127.7 per 1,000 MIS surgeries vs 69.2 per 1,000 open surgeries), but starting in 2010, the risk of complications was more than 60% lower for MIS patients (RR 0.37, 95% CI 0.29–0.48). Conclusions: Treatment of cervical cancer with MIS significantly reduces the risk of postoperative complications and length of hospitalization. Although there was no difference in rate of perioperative deaths, improved patient outcomes without a significant change in operative time may lead to cost savings to the health system. MIS should be considered for patients undergoing surgical treatment of cervical cancer.
improved progression-free survival (PFS) in the bevacizumab + chemotherapy arm compared with chemotherapy alone. The goal of this study was to evaluate the cost-effectiveness of adding bevacizumab to single-agent chemotherapy in the treatment of platinum-resistant recurrent ovarian cancer. Methods: A decision tree model was constructed to evaluate the cost-effectiveness of adding bevacizumab to standard treatment with single-agent chemotherapy based on the arms of the AURELIA trial. Costs, quality-adjusted life years (QALYs), and PFS were modeled over a 15-month period. All model inputs were extracted from published peer-reviewed literature and public sources. Costs and QALYs were discounted at an annual 3% rate. All costs were adjusted to 2015 US dollars. Incremental cost-effectiveness ratios (ICERs) per QALY gained and ICERs per progression-free life year saved (PF-LYS) were calculated. Probabilistic sensitivity analyses were performed to evaluate the robustness of results. Results: The ICER associated with bevacizumab + chemotherapy is $285,624 per QALY gained and $151,059 per PF-LYS. At a willingnessto-pay (WTP) threshold of $50,000/QALY, adding bevacizumab to single-agent chemotherapy is not cost-effective in this patient population. Even at a WTP threshold of $100,000/QALY, bevacizumab + chemotherapy is not cost-effective. These findings are robust to deterministic and probabilistic sensitivity analyses. Conclusions: Despite gains in QALY and PFS, the addition of bevacizumab to single-agent chemotherapy for treatment of platinum-resistant recurrent ovarian cancer is not cost-effective at a WTP threshold of $50,000/QALY. Benefits, risks, and costs associated with treatment should be taken into consideration when prescribing chemotherapy for this population of patients.
OF
Conclusions: The overall 5-year survival for RoRHBPLND for treatment of clinical stage I cervical is 87.5%. There was no difference in 5-year survival among RoRHBPLND, LRHBPLND, and ORHBPLND.
RO
36
TE
doi:10.1016/j.ygyno.2016.04.116
CO
RR
EC
85 - Featured Poster Session A cost-effectiveness analysis of the AURELIA trial: Bevacizumab and paclitaxel offer a promising clinical and economic combination for platinum-resistant ovarian cancer J.L. Lesnocka, C.A. Hamiltonb, K.M. Darcyc, L.J. Havrileskyd, T.C. Krivake, G.L. Maxwellf, W.J. Loweryb. aMid Atlantic Gynecologic Oncology of Mon General Hospital, Morgantown, WV, USA, bMurtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA, cGynecologic Cancer Center of Excellence, Annandale, VA, USA, dDuke University Medical Center, Durham, NC, USA, eWestern Pennsylvania Hospital, Pittsburgh, PA, USA, fInova Fairfax Hospital, Falls Church, VA, USA
UN
doi:10.1016/j.ygyno.2016.04.115
84 - Featured Poster Session Adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer: A cost-effectiveness analysis of the AURELIA trial W.Z. Wysham, E.M. Schaffer, T.M. Coles, D.R. Roque, S.B. Wheeler, K.H. Kim. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Objectives: AURELIA was a randomized phase III trial of adding bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer that demonstrated
Objectives: To evaluate the cost-effectiveness of bevacizumab use in platinum resistant-ovarian cancer (PR-OC). Methods: Decision-analysis models were constructed to evaluate each of the treatment arms of the AURELIA trial. Arm 1 of each model included the standard chemotherapy regimen: liposomal doxorubicin, topotecan, or paclitaxel. Arm 2 included the standard regimen with the addition of bevacizumab (doxorubicin + bevacizumab, topotecan + bevacizumab, or paclitaxel + bevacizumab). Overall survival (OS), rates of adverse events (AEs), and rates of salvage bevacizumab in each arm were obtained from the AURELIA trial. Table 1 lists these rates as well as costs for each treatment arm, based on average number of chemotherapy cycles. Treatment strategies were compared using an incremental cost-effectiveness ratio (ICER) and a standard willingness to pay threshold of $100,000/year of life saved (YLS). Sensitivity analyses were performed to account for uncertainty in assumptions. Results: The paclitaxel arm with a median OS of 13.2 months was the least costly arm with an average cost of $10,386. The