CHICAGO — More transparency regarding the costs of various treatment regimens in real time is needed to “choose wisely” for patients, providers, and payers, said Rena M. Conti, PhD, at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting.

In a presentation on value in cancer care, Dr Conti, associate professor and an economist at the University of Chicago, discussed 3 posters presented this year at the ASCO Annual Meeting.1 The first was a global cost-effectiveness analysis of first-line bevacizumab in metastatic colorectal cancer from the perspective of payers in the United States, United Kingdom, Canada, Australia, and Israel.2

This study used a Markov model of metastatic colorectal cancer with inputs from efficacy, safety, and quality-of-life data. Quality-of-life data were assumed to be stable, Dr Conti noted. Researchers found that reimbursements vary widely but adding bevacizumab to frontline therapy is consistently not cost-effective across countries.2

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“This study assumed stability of treatment intensity across countries,” Dr Conti added. “Patients in Israel do not receive the same care as those treated in the United States.”

The second study evaluated regimen-specific costs, including total and out-of-pocket costs, of trastuzumab-containing and non-trastuzumab-containing regimens among commercially insured patients with breast cancer.3

This study analyzed MarketScan data collected between 2008 and 2012 from outpatients and inpatients who were 18 months post-diagnosis. Results showed that costs vary widely across regimens, even across those exhibiting comparable efficacy, and out-of-pocket expenses are substantial but do not vary by regimen.3

However, Dr Conti explained that this study needs to break out costs/out-of-pocket expenses by treatment input and the claims do not capture couponing or charity care.

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The final study reassessed the cost-effectiveness or cost-utility of regimens previously evaluated in 4 Canadian randomized controlled trials that included a total of 1979 patients with various types of cancer. These studies included erlotinib, cetuximab, and cisplatin — 3 drugs for which genericization has taken place or is expected.4

The study demonstrated that genericization of costly oncology drugs can significantly improve the cost-effectiveness/cost-utility of cancer therapies; however, it assumes that care conforms to the trial following drug launch and there was no detail on price measures.4

Dr Conti concluded: “We need more and better data of ‘real-world’ costs across all patients, insurers, and care settings.”


  1. Conti RM. Choosing wisely: Value in drug cost. Presented at: 2016 American Society of Clinical Oncology (ASCO) Annual Meeting; Chicago, IL.
  2. Goldstein DA, Chen Q, Ayer T, et al. Bevacizumab (bev) for metastatic colorectal cancer (mCRC): A global cost-effectiveness analysis. J Clin Oncol. 2016; 34 (suppl; abstr 6518).
  3. Giordano SH, Niu J, Gregor MC, et al. Regimen-specific costs of chemotherapy for breast cancer (BC). J Clin Oncol. 2016; 34 (suppl; abstr 6519).
  4. Cheung WY, Mittmann N, Leighl NB, et al. The economic impact of the transition from branded to generic oncology drugs. J Clin Oncol. 2016; 34 (suppl; abstr 6520).