Avastin or bevacizumab is one of the most expensive drugs that is currently marketed. In many countries with national health services, the use of bevacizumab has been restricted based on cost-benefit calculations that suggest the drug is not cost-effective.
The National Institute for Health and Care Excellence (NICE) does not approve of the NHS funding the use of bevacizumab because estimates show the cost is £21,000 per patient, with only minimal benefits seen in many cases. One study published in the New England Journal of Medicine reported that bevacizumab extended life by 4.7 months (20.3 months versus 15.6 months) at a cost of $42,800 to $55,000.
The cost of Avastin as currently supplied by the manufacturer is £1,848.80 per month for a typical 70 kg patient. The recommended dosage is 5 mg/kg and is to be given once every 14 days as an intravenous infusion until disease progression is slowed.
In 2000, the rate of death in England and Wales due to colorectal cancer was around 29 per 100,000 population and it has been estimated that around 15 patients per 100,000 may benefit from chemotherapy that may include bevacizumab treatment.
Based on the current cost of supplying bevacizumab (£1,848.80 per month for a 70 kg person) and the median length of time that treatment is required for (approximately 10 months), the cost of bevacizumab would be around £18,500 per patient treated. This would be in addition to the cost of fluoropyrimidine-based chemotherapy. In Canada, the cost is to the tune of $40,000 per year.
In the United States, insurance companies have refused to pay for all or part of the costs of Avastin therapy and reimbursement is also restricted in Canada due to the low benefit-to-cost ratio.
Reviewed by Sally Robertson, BSc