Bevacizumab Biosimilars Reduce Costs While Maintaining Survival Outcomes in mCRC

A real-world, economic evaluation based on a population-based retrospective cohort study in Ontario, Canada, found that prescribing bevacizumab biosimilars Mvasi and Zirabev as first-line treatments for patients with metastatic colorectal cancer (mCRC) provided cost savings with no differences in life years or quality-adjusted life years (QALYs) compared with the originator (Avastin).

The researchers said the 2 biosimilars were cost-effective “at all conventional willingness-to-pay thresholds, indicating the importance and value of biosimilars for improved health system sustainability.” The real-world, 1-year cost savings associated with the use of one of these biosimilars for 1 patient was $6379 CAD.

The authors noted that the economic burden of cancer treatment is growing, largely driven by the costs of biologic drugs, such as bevacizumab, an antibody targeting vascular endothelial growth factor, an inducer of angiogenesis. Mvasi (Amgen) and Zirabev (Pfizer) are bevacizumab biosimilars approved for first-line treatment of mCRC in the US, Europe, and Canada. Since their approvals for mCRC were based on extrapolation from randomized controlled trials in non-small cell lung cancer, the authors wrote, “there is a paucity of indication-specific randomized-controlled trial and real-world evidence for the use of bevacizumab biosimilars in the first-line setting of mCRC.” Furthermore, they cited previous economic evaluations from several countries that have suggested the bevacizumab reference product is not a cost-effective treatment for mCRC at list prices.

Patients with mCRC in Ontario who received one of the biosimilars (n = 742) were matched 1:4 to patients who received the reference product (n = 2945). Of patients who were treated with biosimilars, 635 (86%) received Mvasi and 112 (15%) received Zirabev.

First-line treatment of mCRC with a bevacizumab biosimilar was associated with a 1-year patient-level cost savings of $6379 CAD (95% CI, $3537-$9417), with a mean total cost of $84,162 for a biosimilar compared to $90,541 for the reference bevacizumab. Mean life years and QALYs were not significantly different between the biosimilar and originator groups.

Incremental net monetary benefit was estimated at $6331 (95% CI, 6245-6417) and incremental net health benefit (INHB) was estimated at 0.127 life years (95% CI, 0.125-0.128) at a willingness-to-pay threshold of $50,000 per life year gained. The authors added that INMB and INHB estimates also indicated cost-effectiveness of the biosimilars compared to the reference product at willingness-to-pay thresholds of $100,000, $150,000, and $200,000 per life year gained. Subgroup analyses by biosimilar product and 2-year analyses suggested “consistent” cost-effectiveness.

The authors said their study confirms the benefits and cost-savings possible with bevacizumab biosimilars in mCRC and justifies Ontario’s policy to mandate the use of biosimilars for treating mCRC. They said their study can inform future policy decisions elsewhere in Canada and in other regions around the funding of bevacizumab biosimilars. “Decision makers can rely on the evidence of cost savings achieved through the use of biosimilars and be confident in the role they play in improving the efficiency and sustainability of the healthcare system,” they wrote.

Reference

Lu B, Dvorani E, Nguyen L, Beca JM, Mercer RE, Adamic A, Muñoz C, Chan KKW. Cost-effectiveness analysis of bevacizumab biosimilars versus originator bevacizumab for metastatic colorectal cancer: a comparative study using real-world data. Value Health. 2024;27(12):1689-1697. doi:10.1016/j.jval.2024.07.018