BEVACIZUMAB FOR BREAST CANCER

Bevacizumab in combination with a taxane for the first-line treatment of HER2 negative metastatic breast cancer: an assessment based on the manufacturer’s submission to NICE

Background

The aim of this NICE STA was to appraise the clinical and cost-effectiveness of bevacizumab in combination with a taxane  within its licensed indication for the treatment of untreated metastatic HER-2 negative breast cancer in patients for whom anthracyclines are not appropriate. CRD researchers together with researchers from the Centre for Health Economics (CHE) comprised the Evidence Review Group for this STA. The work involved a detailed assessment of the manufacturer’s submission to NICE on the clinical and cost-effectiveness of bevacizumab, in combination with a taxane.

Findings

The manufacturer's evaluation of clinical efficacy included only evidence relating to bevacizumab in combination with weekly paclitaxel. Evidence on bevacizumab in combination with docetaxel was excluded. Cost effectiveness analysis focused on a comparison between weekly (qw) paclitaxel plus bevacizumab and paclitaxel qw based on the results of the E2100 trial. Although an indirect comparison was conducted, the results were not implemented in the manufacturer's model. Because of limitations in the existing evidence base, the reliability of indirect estimates of efficacy between bevacizumab plus taxane regimens and other relevant comparators remains uncertain.

 The cost-effectiveness analysis presented by the manufacturer included judgments and assumptions which are subject to uncertainty.  The manufacturer’s most optimistic analyses indicated that a bevacizumab plus taxane regimen was not cost-effective.  Further analysis by the ERG suggested that no plausible changes to the model assumptions would bring bevacizumab plus taxane within the threshold currently considered cost-effective by NICE.

Findings

Because of limitations in the existing evidence base, the reliability of indirect estimates of efficacy between bevacizumab plus taxane regimens and other relevant comparators remains uncertain.

Conducted by: Mark Rodgers1, Marta Soares2, David Epstein2, Huiqin Yang1, Dave Fox1, Alison Eastwood1

1 Centre for Reviews and Dissemination, University of York; 2 Centre for Health Economics, University of York

Further details

Project page on NIHR HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal Guidance: Bevacizumab in combination with a taxane for the first-line treatment of HER2 negative metastatic breast cancer. London: National Institute for Clinical Excellence; 2010

Publications

CRD and CHE Technology Assessment Group. Bevacizumab in combination with a taxane for the first-line treatment of HER2-negative metastatic breast cancer: a Single Technology Appraisal. Centre for Reviews and Dissemination / Centre for Health Economics, 2010

Rodgers M, Soares M, Epstein D, Yang H, Fox D, Eastwood A. Bevacizumab in combination with a taxane for the first-line treatment of HER2-negative metastatic breast cancer. Health Technol Assess. 2011;15(Suppl 1):1-12

Funding

Commissioned by the NIHR HTA Programme in support of NICE's Single Technology Appraisal process.

NICE’s single technology appraisal (STA) process is specifically designed for the appraisal of a single product, device or other technology, with a single indication. The STA process normally covers new technologies and is designed to provide recommendations in the form of NICE guidance soon after the technology is introduced into the UK market. The principal evidence in the STA process is submitted by the manufacturer or sponsor of the technology.