Testing for levels of vascular endothelial growth factor (VEGF)-A, a predictor for response to bevacizumab, to guide whether to add it to chemotherapy regimens for the treatment of patients with breast cancer, could ultimately result in increased quality adjusted life-years (QALYs) for patients at manageable costs, according to findings presented during a Biomarkers in Breast Cancer session of a Poster Walk at the IMPAKT Breast Cancer Conference held 7–9 May 2015 in Brussels, Belgium.
Patients with HER2-negative (HER2-) breast cancer, in particular, have shown only modest benefit from neoadjuvant bevacizumab, leading Patricia Blank, European Center of Pharmaceutical Medicine (ECPM), University of Basel Institute of Pharmaceutical Medicine, Basel, Switzerland and colleagues in Germany and Sweden to evaluate the cost-effectiveness of using VEGF-A testing and corresponding treatment strategies in the neoadjuvant treatment of patients with hormone receptor (oestrogen or progesterone) positive (HR-positive) HER2-negative breast cancer.
The investigators determined the health economic impact as well as the incremental cost-effectiveness ratio (ICER) of VEGF-A-guided use of bevacizumab using a life-long Markov state transition model. They compared six alternative strategies that comprised four different VEGF-A cut-off values, plus two strategies evaluating the use of neoadjuvant bevacizumab in all or no patients.
Data regarding overall and metastasis-free survival of 830 women participating in the GeparQuinto trial were used and effectiveness was assessed as QALYs. The treatment cost was given in euros at the year 2013 value and was assessed from a German third-party payer’s perspective.
QALYs increased with neoadjuvant bevacizumab
Model projections suggested that costs per patient ranged from 37,042 euros for the reference strategy of no additional bevacizumab used in this patient cohort to nearly double the cost of 78,367 euros when bevacizumab was added to all treatment regimens, the second reference strategy.
No bevacizumab treatment yielded 14.031 QALYs per patient.
However, QALYs were increased with VEGF-A guided strategies from to 14.220 with the bevacizumab dose cut-off of 450 pg/mL to 14.235 QALY’s with a cut-off 339 pg/mL.
When compared to no bevacizumab therapy, the preferred strategy was revealed to be a VEGF-A-guided strategy with a cut-off 450 of pg/mL, which showed an increase in QALY‘s of 0.189 per patient at an additional cost of 11,191 euros yielding an ICER of 59,161 euros per QALY.
These findings, according to the investigators, suggest that VEGF-A testing may be sensibly used to guide the addition of bevacizumab to chemotherapy in the treatment of patients with either HR-positive HER2-negative breast cancer. Using Germany as an example, the use of a cut-off value of 450 pg/mL bevacizumab might be cost-effective.
The study was sponsored by the European Commission 7th Framework Programme.