Bevacizumab in the treatment of ovarian cancer

110 p.ill.,SCIENTIFIC REPORT 13 -- 1 INTRODUCTION 13 -- 1.1 BACKGROUND 13 -- 1.2 SCOPE AND OBJECTIVES 13 -- 2 HEALTH PROBLEMS 14 -- 2.1 POPULATION AND CONDITION. 14 -- 2.2 CURRENT TREATMENT GUIDELINES 14 -- 2.3 BELGIAN RECOMMENDATIONS OF GOOD PRACTICE 14 -- 3 DESCRIPTION AND TECHNICAL CHARACTERISTICS 15 -- 3.1 BEVACIZUMAB 15 -- 3.2 BELGIAN RULES FOR THE REIMBURSEMENT OF BEVACIZUMAB 16 -- 4 CURRENT USE 17 -- 4.1 METHODS 17 -- 4.1.1 Data sources 17 -- 4.1.2 Analysis 18 -- 4.2 RESULTS 18 -- 4.2.1 Sample size 18 -- 4.2.2 Staging levels 18 -- 4.2.3 Age at diagnosis 19 -- 4.2.4 Available follow-up 20 -- 4.2.5 Adjuvant chemotherapy 20 -- 5 CLINICAL EFFECTIVENESS AND SAFETY 25 -- 5.1 METHODS 25 -- 5.1.1 Clinical research question 25 -- 5.1.2 Literature search and study selection 25 -- 5.1.3 Quality appraisal and data extraction 26 -- 5.1.4 Statistical analysis 26 -- 5.1.5 GRADE 26 -- 5.2 RESULTS 28 -- 5.2.1 Overview of selected studies 28 -- 5.2.2 Effectiveness in first-line 31 -- 5.2.3 Effectiveness in second-line 32 -- 5.2.4 Safety 34 -- 5.2.5 Ongoing trials 34 -- 5.3 CONCLUSIONS 36 -- 6 COST-EFFECTIVENESS OF BEVACIZUMAB IN OVARIAN CANCER: LITERATURE REVIEW 38 -- 6.1 LITERATURE SEARCH 38 -- 6.1.1 Search strategy 38 -- 6.1.2 Selection criteria 38 -- 6.2 RESULTS OF THE ECONOMIC SEARCH STRATEGY 39 -- 6.3 OVERVIEW OF ECONOMIC EVALUATIONS 41 -- 6.3.1 General information 41 -- 6.3.2 Population, intervention and comparator(s) 41 -- 6.3.3 Costs 46 -- 6.3.4 Adverse events 48 -- 6.3.5 Quality of life 50 -- 6.3.6 Treatment effect. 53 -- 6.3.7 Uncertainty 57 -- 6.3.8 Results 59 -- 6.3.9 Authors’ conclusions 65 -- 7 COST-EFFECTIVENESS OF BEVACIZUMAB IN OVARIAN CANCER IN BELGIUM 67 -- 7.1 INPUT 67 -- 7.1.1 Perspective of the evaluation 67 -- 7.1.2 Population 67 -- 7.1.3 Intervention and comparator 70 -- 7.1.4 Analytical technique 71 -- 7.1.5 Time horizon and discount rate 72 -- 7.1.6 Markov model 72 -- 7.1.7 Treatment effect. 72 -- 7.1.8 Quality of life 75 -- 7.1.9 Costs 78 -- 7.1.10 Validation of the model 84 -- 7.2 RESULTS 84 -- 7.2.1 Base case results and scenario analyses 84 -- 7.2.2 Validation of modelling outcomes 93 -- 7.3 CONCLUSION 97 -- 8 DISCUSSION 98 -- 8.1 UNPROVEN EFFECTIVENESS OF FIRST-LINE BEVACIZUMAB ON OVERALL SURVIVAL AND QUALITY OF LIFE, BUT SUBGROUPS MAY BENEFIT 98 -- 8.2 POSITIVE EFFECT OF SECOND-LINE BEVACIZUMAB ON PROGRESSION-FREE SURVIVAL AND ONE ITEM OF QUALITY OF LIFE, BUT NOT ON OVERALL SURVIVAL 99 -- 8.3 IS BEVACIZUMAB A SAFE TREATMENT? 99 -- 8.4 WHICH OUTCOMES DO MATTER? 99 -- 8.5 RESULTS AND LIMITATION OF CURRENT MODEL 100 -- 8.6 LIMITATIONS OF SUBGROUP ANALYSES 101 -- 8.7 BUDGET IMPACT FOR STAGE IV SUBGROUP IN FIRST LINE 102 -- 8.8 QOL 103 -- 8.9 DOSE 104 -- 8.10 CONFIDENTIAL CONTRACTS AND CHANGING REIMBURSEMENT CONDITIONS 104 --  REFERENCES 10