Cost-effectiveness analysis of VEGF-C: A novel predictive biomarker for response to bevacizumab in the neoadjuvant therapy of early breast cancer patients

Background: It has been demonstrated that VEGF-C level has predictive value for determining pathological complete response (pCR) with bevacizumab treatment in the neo-adjuvant setting. We aimed to estimate the cost-effectiveness of using VEGF-C testing and corresponding treatment strategies in patients with triple negative breast cancer (TNBC), from a German third-party payer perspective. Methods: Using a life-long Markov state transition model, we determined the costs (EUR) and effects (quality-adjusted life years, QALYs) of VEGF-C guided use of bevacizumab therapy. Information on overall and metastasis-free survival derived from the GeparQuinto (n = 830, EudraCT No: 2006-005834-19) trial. Six alternative strategies were compared: four using different VEGF-C cut-off values; two implying the use of bevacizumab in none or all the patients, regardless of VEGFC level. Costs and effects were discounted by 3% p.a. Results: Lifetime costs per patient ranged from EUR 40,226 (reference strategy of no bevacizumab therapy) to EUR 82,047. No bevacizumab therapy yielded 8.141 QALYs per patient. In comparison with no bevacizumab therapy, the most preferable strategy (cut-off 2600 pg/mL) yielded additional costs of 10,060 EUR and 0.338 QALYs per patient (incremental cost-effectiveness ratio, 29,722 EUR/QALY) (Table 1, only undominated strategies shown). Results remained robust in sensitivity analyses. Conclusions: Our study suggests that VEGF-C could be sensibly used to guide the neo-adjuvant administration of bevacizumab in TNBC. Compared to current practice of not using bevacizumab in this setting, the use of a cut-off value of 2600 pg/mL might be cost-effective in Germany. (Table Presented).