Ademi, Z.

Blank, P.R.

Caramuta, S.

Linderholm, B.K.

Loibl, S.

Nekljudova, V.

Schwenkglenks, M.

Szucs, T.D.

Van Stiphout, J.

von Minckwitz, G.

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biomarkers in breast cancer(prognostic, predictive andpharmacodynamic)45P Cost-effectiveness analysis of VEGF-A testing to predictresponse to bevacizumab (BEV) as a component ofneo-adjuvant therapy of early HER-2 negative breast cancerP.R. Blank1, S. Loibl2, B.K. Linderholm3, S. Caramuta3, V. Nekljudova2,T.D. Szucs1, J. Van Stiphout1, Z. Ademi1, G. von Minckwitz2, M. Schwenkglenks11European Center of Pharmaceutical Medicine (ECPM), University of BaselInstitute of Pharmaceutical Medicine, Basel, Switzerland2Medicine and Research, German Breast Group, GBG Forschungs GmbH,Neu-Isenburg, Germany3Department of Oncology/Pathology, Karolinska University Hospital andKarolinska Institute-Huddinge, Stockholm, SwedenBackground: The effect of BEV to neo-adjuvant chemotherapy is modest in unselectedHER2-negative (HER2-) breast cancer (BC) patients. VEGF-A has been suggested as apredictor for response to neoadjuvant BEV. We estimated the cost-effectiveness ofusing VEGF-A testing and corresponding treatment strategies in the neoadjuvanttreatment of hormone receptor (estrogen or progesterone) positive (HR+), HER2- BC.Methods: Using a life-long Markov state transition model, we determined the healtheconomic impact and incremental cost-effectiveness ration (ICER) of VEGF-A guideduse of BEV therapy. Six alternative strategies were compared (four different VEGF-Acut-off values; two implying the use of BEV in no or all patients. Overall andmetastasis-free survival information was derived from GeparQuinto (n = 830) trial(EudraCT No: 2006-005834-19). Effectiveness was assessed as quality-adjustedlife-years (QALYs). Costs (in EUR, year 2013) were assessed from a Germanthird-party payer perspective.Results: Lifetime costs per patient ranged from EUR 37’042 (reference strategy; noBEV) to EUR 78’367 (BEV to all). No BEV therapy yielded 14.031 QALYs per patient.The VEGF-A guided strategies achieved between 14.220 (cut-off 450 pg/mL) and14.235 (cut-off 339 pg/mL) QALYs. In comparison with no BEV therapy, the mostpreferable strategy (cut-off 450 pg/mL) yielded additional costs of 11’191 EUR and0.189 QALYs per patient (ICER 59’161 EUR/QALY) (Tab 1, only undominatedstrategies shown). Results remained robust in deterministic sensitivity analyses.Conclusion: Our study suggests that VEGF-A testing could be sensibly used toguide the neo-adjuvant administration of BEV in HR+ HER2- BC. Compared to notusing BEV, the use of a cut-off value of 450 pg/mL might be cost-effective inGermany. Tab 1Table: 45PCost(EUR)IncrementalCost (EUR)QALY Incrementaleffect (QALY)ICER (EUR/QALY)No test, no BEV 37’042 14,031VEGF-A 450 48’233 11’191 14,220 0,189 59’161(vs. reference)VEGF-A 400 50380 1’338 14,230 0,199 227’344(vs. VEGF-A 450)VEGF-A 339 54’061 17’019 14,235 0,204 673’769(vs. VEGF-A 400)Disclosure: All authors received funding from the European Commission 7thFramework Programme, Call FP7-HEALTH-2011-two-stage, under grant agreementNo 278659 (RESPONSIFY).© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology.All rights reserved. For permissions, please email: journals.permissions@oup.com.abstractsAnnals of Oncology 26 (Supplement 3): iii15–iii24, 2015doi:10.1093/annonc/mdv117.7

45PCost-effectiveness analysis of VEGF-A testing to predict response to bevacizumab (BEV) as a component of neo-adjuvant therapy of early HER-2 negative breast cancer

http://doc.rero.ch/record/302675/files/mdv117.07.pdf

45PCost-effectiveness analysis of VEGF-A testing to predict response to bevacizumab (BEV) as a component of neo-adjuvant therapy of early HER-2 negative breast cancer

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