Cost-effectiveness analysis of bevacizumab combined with lomustine in the treatment of progressive glioblastoma using a Markov model simulation analysis

Our plain-English summary of Cost-effectiveness analysis of bevacizumab combined with lomustine in the treatment of progressive glioblastoma using a Markov model simulation analysis, by Z. Chen, F. Tian, Y. Zhang (Frontiers in Public Health, 2024).

The study

• Authors: Z. Chen, F. Tian, Y. Zhang
• Journal: Frontiers in Public Health
• Published: 2024;12:1410355
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Progressive glioblastoma (GBM) is a malignancy with extremely poor prognosis. Chemotherapy is one of the approved systemic treatment modalities. The aim of this study is to assess the cost-effectiveness of using bevacizumab (BEV) in combination with lomustine (LOM) regimen for the treatment of progressive glioblastoma in China.

Methods: The estimation results are derived from a multicenter randomized phase III trial, which demonstrated improved survival in GBM patients receiving BEV+LOM combination therapy. To calculate the incremental cost-effectiveness ratio (ICER) from the perspective of Chinese society, a Markov model was established. Univariate deterministic analysis and probabilistic sensitivity analysis were employed to address the uncertainties within the model.

Results: Compared to LOM monotherapy, the total treatment cost for BEV+LOM combination therapy increased from $2,646.70 to $23,650.98. The health-adjusted life years (QALYs) for BEV+LOM combination therapy increased from 0.26 QALYs to 0.51 QALYs, representing an increment of 0.25 QALYs. The incremental cost-effectiveness ratio (ICER) was $84,071.12. The cost-effectiveness curve indicates that within the willingness-to-pay (WTP) range of $35,906 per QALY, BEV+LOM combination therapy is not a cost-effective treatment option for unresectable malignant pleural mesothelioma patients.

Conclusions: Taken as a whole, the findings of this study suggest that, from the perspective of payers in China, BEV+LOM combination therapy as a first-line treatment for GBM is not a cost-effective option. However, considering the survival advantages this regimen may offer for this rare disease, it may still be one of the clinical treatment options for this patient population.

Copyright © 2024 Chen, Tian and Zhang.

In plain English

This study was not about asbestos. It was a computer-model (Markov model) cost-effectiveness analysis of treatment for progressive glioblastoma, a brain cancer, in China. The authors simulated patients matching those in an earlier large clinical trial and compared bevacizumab plus lomustine with lomustine alone over 10 years. In the model, total cost was $23,650.98 for the combination and $2,646.70 for lomustine alone. Quality-adjusted life years (QALYs) were 0.51 and 0.26, a gain of 0.25. The extra cost per QALY gained was $84,071.12. That was above the $35,906 per QALY threshold the authors used, which is three times China's 2022 per capita GDP. Three inputs swayed results most: the cost of the progression-free state in the combination group, the price of bevacizumab, and the progression-free utility value. In the probabilistic analysis the ratio stayed above the threshold. The authors concluded that the combination is not economically feasible in China under current insurance policies. They noted that the model relied on trial data with no Chinese patients. The article several times mentions 'malignant pleural mesothelioma', but the model concerned glioblastoma only.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cost-effectiveness analysis using a Markov model simulation (not a study of real patients)
• Who was studied: Simulated patients with progressive glioblastoma whose baseline characteristics matched an earlier large clinical trial. The analysis took the perspective of the Chinese healthcare system and used a 10-year time frame.
• Exposure: No asbestos or fiber exposure was studied. The comparison was between two drug treatments: bevacizumab plus lomustine versus lomustine alone.
• Main results:
  • Total treatment cost was $23,650.98 for bevacizumab plus lomustine versus $2,646.70 for lomustine alone.
  • QALYs were 0.51 for bevacizumab plus lomustine versus 0.26 for lomustine alone, an increase of 0.25.
  • The incremental cost-effectiveness ratio for the combination compared with lomustine alone was $84,071.12 per QALY.
  • The cost-effectiveness threshold used was $35,906 per QALY, three times China's per capita GDP in 2022.
  • In one-way sensitivity analysis, three inputs had the greatest influence: the cost of the progression-free state in the combination group, the drug cost of bevacizumab, and the utility value of the progression-free state.
  • In probabilistic sensitivity analysis (1,000 iterations), the ICER remained above $35,906 per QALY.
• The authors' conclusion: The authors concluded that, from the perspective of Chinese taxpayers, bevacizumab combination therapy is not economically feasible for patients with progressive glioblastoma under current medical insurance policies. They also stated that drug donation programs and social assistance should be encouraged.
• Limitations the authors state:
  • The model was based on clinical trial data rather than real-world population data, and no Chinese patients were involved.
  • Costs came from drug price disclosure websites and local hospitals, so the results are time-dependent.
  • Whether the willingness-to-pay threshold used is fair for rare diseases remains unclear.

Topics

Medical terms in this study, explained in our Lexicon: Bevacizumab, Prognosis, Chemotherapy, Unresectable, Pleural Mesothelioma.

Related studies

• Cost-effectiveness analysis of additional bevacizumab to pemetrexed plus cisplatin for malignant pleural mesothelioma based on the MAPS trial — M. Zhan, H. Zheng, et al. (2017)
• Cost Effectiveness and Budget Impact of Nivolumab Plus Ipilimumab Versus Platinum Plus Pemetrexed (with and Without Bevacizumab) in Patients with Unresectable Malignant Pleural Mesothelioma in Switzerland — M.C. Barbier, A. Fengler, et al. (2023)
• Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma — Z.M. Ye, Z.Q. Tang, et al. (2022)
• First-line nivolumab plus ipilimumab for unresectable MPM in China: a cost-effectiveness analysis — L. Yang, X. Song, et al. (2023)
• A review of bevacizumab in the treatment of malignant pleural mesothelioma — S. Brosseau, S. Assoun, et al. (2017)
• Tumour treating fields therapy for glioblastoma: current advances and future directions — O. Rominiyi, A. Vanderlinden, et al. (2021)

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