Switching From Avastin to Bevacizumab-bvzr in CRC, NSCLC Can Reduce Medicare Costs

The monthly savings from a 100% conversion of Medicare patients with metastatic colorectal cancer (mCRC) and non-squamous metastatic non-small cell lung cancer (mNSCLC) from the reference bevacizumab (Avastin) to bevacizumab-bvzr (Zirabev; Pfizer) could fund 13,887 additional patient-months of treatment in mCRC and 8,959 in mNSCLC, concluded the authors of a cost-effectiveness study.

Originator bevacizumab, a vascular endothelial growth factor inhibitor, is approved by the FDA for multiple solid tumor indications, including first-line treatment of mCRC in combination with fluorouracil-based chemotherapy, and first-line treatment of unresectable, locally advanced, recurrent, or mNSCLC in combination with carboplatin and paclitaxel. According to the authors, although bevacizumab has improved outcomes in mCRC and mNSCLC, treatment costs may exceed $11,000 per patient per month.

After the reference product lost exclusivity in the US in 2019, Zirabev was the first biosimilar to be approved by the FDA and enter the US market. Additional biosimilars have since been approved, including bevacizumab-adcd, bevacizumab-awwb, and bevacizumab-maly.

Medicare is one of the largest payers for bevacizumab therapy in the US, the authors said, spending approximately $700 million in 2022. Thus, the authors aimed to estimate cost savings and potential for expanded access to therapy associated with substituting a biosimilar for the originator.

The simulation model estimated cost savings from using bevacizumab-bvzr or alternative biosimilars (bevacizumab-awwb, -maly, or -abcd) in place of the originator. They used Medicare enrollment data, SEER cancer incidence data, and the 2024 average sales price (ASP) to estimate numbers of patients expected to be treated and costs.

Assuming a 100% market shift from the originator to bevacizumab-bvzr, the per-patient per-month (PPPM) cost savings compared to the originator were $4,205 in mCRC. For the full mCRC cohort, the monthly savings were estimated at $27,664,432, a 68% reduction in cost. The number needed to convert (NNC) was 47 to treat an additional 100 patients with bevacizumab-bvzr + FOLFOX.

In mNSCLC, the mean PPPM savings were $8,410, and monthly savings in the full cohort were $32,319,323, a 70% reduction in cost compared to the reference product. The NNC to treat an additional 100 patients with bevacizumab-bvzr + paclitaxel + carboplatin was 43.

Bevacizumab-bvzr had the lowest ASP of the bevacizumab biosimilars. The cost savings associated with converting to bevacizumab-bvzr exceeded those for the alternative biosimilars in both indications. NNCs in mCRC for alternative biosimilars ranged from 60 to 4,564 and 55 to 4,422 in mNSCLC. “Medicare can potentially achieve the greatest degree of budget-neutral expanded access to bevacizumab through increased use of bevacizumab-bvzr,” the authors wrote.

Overall, bevacizumab biosimilars were more cost-effective than the reference product in all scenarios the authors modeled, and bevacizumab-bvzr was the most cost-effective for treating both mCRC and mNSCLC. The authors said the substantial cost savings to Medicare from converting from the reference product to bevacizumab-bvzr could be reinvested to treat more patients or fund other costs in Medicare on a budget-neutral basis, and that the cost savings could be passed on to patients to improve the affordability of treatment.

Reference

Roth JA, Kratochvil D, Dorman S, Bernauer M. Cost-efficiency and expanded access modeling of conversion to biosimilar bevacizumab in metastatic colorectal and non-squamous non-small cell lung cancer in Medicare. J Med Econ. 2025;28(1):378-386. doi:10.1080/13696998.2025.2474884