ASCO studies you didn’t read about in the news–statistical significance vs cost

#6057: Examining the cost and cost-effectiveness of adding bevacizumab to carboplatin and paclitaxel in advanced non-small cell lung cancer. The addition of bevacizumab (Avastin) an inhibitor of vascular endothelial growth factor (VEGF), to platinum-based chemotherapy (paclitaxel and carboplatin) improved survival of advanced lung cancer patients from 10.2 months to 12.5 months. This abstract reviewed the cost of adding this new drug to the treatment regimen. Bevacizumab patients lived 2.3 months longer and accrued costs of between $66,000-$80,000 more. The cost/QALY (see previous post for explanation) was over $345,000 and is not considered cost effective.

Note: The good news is that the targeted treatment had an impact on survival. The bad news is that the treatment, as priced, is not cost effective. Patients with advanced cancer given the choice of therapy with a small possibility of remission will almost inevitably give the treatment a try despite toxicity and cost. ence the Hence the high costs of care in the last year of patient’s lives.

#6048: Is it cost-effective to add erlotinib to gemcitabine in advanced pancreatic cancer?
569 patients were randomized to receive standard therapy with gemcitabine alone or gemcitabine + erlotinib (tyrosine kinase epidermal growth factor inhibitor) as first line therapy. There was a small but statistically significant difference in survival (6.0 vs 6.4 months, respectively, p = .028). Gemcitabine alone costs $23,493. Erlotinib (Tarceva) increased cost by $16,613 retail. Erlotinib improved survival by .4 months but estimates for the cost/year of life gained were between $364,680 wholesale pricing and $498,379/YLG retail.

Note: Another study with some positive news, the improvement of survival. However, the cost is prohibitive given the very limited benefit.

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