Cost-Utility Analysis Addition of Bevacizumab to Standard Chemotherapy in KRAS-mutation Colorectal Cancer
DOI:
https://doi.org/10.30595/pharmacy.v22i1.24298Keywords:
Colorectal Cancer, Bevacizumab, Markov model, ICERAbstract
There is a high incidence of colorectal cancer in Indonesia. Colorectal cancer was ranked fourth with an incidence of 8.6% and a colon cancer mortality rate of 4% while rectal cancer was 3.6% in Indonesia. The addition of Bevacizumab to Standard chemotherapy (FOLFOX/FOLFIRI/XELOX) in KRAS-mutation colorectal cancer patients has better clinical outcomes; however, it has a very high cost in terms of colorectal cancer treatment. The objective of this study was to determine the utility and economic impact of adding Bevacizumab as an adjunct therapy for KRAS-mutation colorectal cancer patients. A Markov model was developed to estimate the Cost-utility analysis (CUA) using a societal perspective. Humanistic outcomes are expressed in the form of QALY (Quality-adjusted life years) using an EQ-5D-5L instrument with an Indonesian value set. Medical expenses data were collected from both RSUP Dr. Sardjito and patients. Utility data were obtained from interviews with 30 patients undergoing chemotherapy at the hospital. This study compared the cost and utility of patients receiving Bevacizumab supplementation or patients receiving standard chemotherapy alone. The societal perspective resulted in a cost-effectiveness ratio (ICER) of US$3.098 per QALY. The addition of Bevacizumab to standard chemotherapy in KRAS-mutation colorectal cancer patients is considerably cost-effective from a societal perspective.
References
Andriani Y, Kristina SA, Wiedyaningsih C. 2021. Estimasi biaya pengobatan langsung penyakit kanker di Indonesia: Estimasi direct medical cost (DMC), Majalah Farmasetik, 17(3), 251-255.
Aparicio T, Bouch ́O, Taieb J. 2017. Bevacizumab + chemotherapy versus chemotherapy alone in elderly patients with untreated metastatic colorectal cancer: A randomized phase II trial PRODIGE 20 study results, Annals of Oncology, 29(1), 133-138.
Azzani M, Roslani AC, Su TT. 2016. Financial burden of colorectal cancer treatment among patients and their families in a middle-income country, Support Care Cancer, 24(10),4423-4432.
BPS. 2023. Pertumbuhan Ekonomi Indonesia Triwulan IV-2022. Badan Pusat Statistik, Jakarta.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries, CA: A Cancer Journal for Clinicians, 68(6), 394-424.
Byun JY, Yoon SJ, Oh IH, Kim YA, Seo HY, Lee YH. 2014. Economic Burden of Colorectal Cancer in Korea, Journal of Preventive Medicine and Public Health, 47(2), 84–93.
Cunningham D, Lang I, Marcuello E. 2013. Bevacizumab plus capecitabine versus Capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): An open-label, randomised phase 3 trial, Lancet Oncology, 14(11), 1077-1085.
Ferlay J, Ervik M, Lam F, Colombet M. 2020. Cancer Today (powered by GLOBOCAN 2018). International Agency for Research on Cancer.
Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP. 2007. Bevacizumab in Combination with Oxaliplatin, Fluorouracil, and Leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: Results from the Eastern Cooperative Oncology Group study E3200, Journal of Clinical Oncology, 25(12), 1539-1544.
Heinemann V, von Weikersthal LF, Decker T. 2014. FOLFIRI plus cetuximab versus FOLFIRI plus Bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): A randomised, open-label, phase 3 trial, Lancet Oncology, 15, 1065-1075.
Kemenkes RI. 2017. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Kanker Kolorektal. Kementerian Kesehatan Republik Indonesia, Jakarta.
KPTK. 2022. Pedoman Umum Penilaian Teknologi Kesehatan di Indonesia. Pusat Kebijakan Pembiayaan Dan Desentralisasi Kesehatan Badan Kebijakan Pembangunan Kesehatan Kementerian Kesehatan RI, Jakarta.
Kristin E, Khoe LC, Endarti D, Widayati K. 2021. Economic evaluation of adding Bevacizumab to chemotherapy for metastatic colorectal cancer (mCRC) patients in Indonesia, Asian Pacific Journal of Cancer Prevention, 22(6), 1921-1926.
NCCN. 2023. NCCN Clinical Practice Guidelines in Oncology Colon Cancer.
Purba FD, Hunfeld JAM, Iskandarsyah A. 2017. The Indonesian EQ-5D-5L value set, PharmacoEconomics, 35(11), 1153–1165.
Setiawan D, Endarti D, Suwantika A. 2017. Farmakoekonomi Modeling. UM Purwokerto Press, Purwokerto.
Tappenden P, Jones R, Paisley S, Carroll C. 2007. The cost-effectiveness of Bevacizumab in the first-line treatment of metastatic colorectal cancer in England and Wales, European Journal of Cancer, 43(17), 2487-2494.
Tran BT, Choi KS, Nguyen TX. 2020. The direct and indirect costs of colorectal cancer in Vietnam: An economic analysis from a social perspective, International Journal of Environmental Research and Public Health, 18(1), 12.
Ungari AQ, Pereira LRL, Nunes AA, Peria FM. 2017. Cost-effectiveness analysis of XELOX versus XELOX plus Bevacizumab for metastatic colorectal cancer in a public hospital school, BMC Cancer, 17(1), 691.
Vahdatimanesh Z, Zendehdel K, Sari AA, Farhan F, Nahvijou A, Delavari A, Daroudi R. 2017. Economic burden of colorectal cancer in Iran in 2012, Medical Journal of the Islamic Republic of Iran (MJIRI), 31, 115
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 PHARMACY: Jurnal Farmasi Indonesia (Pharmaceutical Journal of Indonesia)

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
