A Narrative Review of the Cost-Effectiveness of Bevacizumab in Colorectal Cancer Treatment
Keywords:
Bevacizumab, colorectal cancer, cost-effectiveness, chemotherapyAbstract
Introduction: Colorectal cancer (CRC) is one of the most prevalent malignancies globally and a major cause of cancer-related mortality. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has demonstrated clinical efficacy in combination with chemotherapy for metastatic CRC (mCRC). However, its high cost raises concerns regarding cost-effectiveness, particularly in resource-limited settings. Objective: This study aimed to evaluate the cost-effectiveness of adding bevacizumab to chemotherapy through a narrative review of recent economic evaluations. Methods: A literature search was conducted in PubMed, Scopus, and ScienceDirect to identify studies published between 2020 and 2025. Six eligible studies were included, most of which were conducted in high- or upper-middle-income countries. Data on incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs), and willingness-to-pay (WTP) thresholds were extracted and analysed. Results: All studies used ICERs as the primary outcome and applied country-specific WTP thresholds. The majority concluded that adding bevacizumab was not cost-effective, primarily due to high ICERs exceeding WTP thresholds. Although clinical benefits such as improved progression-free and overall survival were reported, the economic value of bevacizumab remains limited due to its high cost, complex manufacturing, and originator pricing. One study suggested potential cost-effectiveness with biosimilar bevacizumab, and another supported optimized dosing strategies. Conclusion: In conclusion, while bevacizumab offers clinical advantages, its addition to standard chemotherapy in mCRC is generally not cost-effective under current pricing. Further context-specific research is needed to support informed decision-making, especially in constrained healthcare systems
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