Use of Bevacizumab for Newly Diagnosed Ovarian Cancer: A National Analysis

Objective: To describe the use patterns and costs of bevacizumab (BEV) for the upfront treatment of ovarian cancer (OC) in the US. Methods: We identified women ages 18 – 65 with newly diagnosed OC from 2008 to 2016 through the Truven Health MarketScan® database. Of these, women who underwent cancer-directed surgery and platinum-based chemotherapy within 6 months of diagnosis were included (N=8109). The proportion of women receiving BEV was calculated and multivariate logistic regression was used to determine factors associated with BEV use. Total costs per cycle of BEV were calculated. Results: About 6.4% (N=522) of new OC cases received BEV within 6 months of diagnosis. Rates of BEV use increased 1.8-fold, from 4.1% (2008) to 7.4% (2016), with peak use in 2014 (8.5%). Patients receiving BEV were less likely than those not receiving BEV to be treated with a platinum/taxane doublet (46.4% v 90.4%) and more likely to be treated with platinum monotherapy (51.3% v 5.4%) (p<0.001). More recent year of diagnosis, younger age, presence of ascites or metastatic disease, treatment by a medical oncologist, and residing in the Southern US were associated with statistically higher odds of receiving BEV (p<0.01). The median cost of one cycle of BEV monotherapy was $6873 [IQR:$4,824–11,276] and the cost of one cycle of platinum/taxane/BEV was $ 10,897 [IQR:$7,573–18,133]. Conclusion: BEV use has increased over the years and is related to several clinical and non-clinical factors. BEV has been used with non-standard regimens (platinum/taxane) over half the time and its cost is highly variable.