OBJECTIVES: The objective was to assess the cost-minimization of bevacizumab in first-line treatment of KRAS wild-type metastatic colorectal cancer (mCRC) in comparison to cetuximab and panitumumab in France. METHODS:  A three health states economic model: free survival, progressive disease and death, was developed to assess the cost-effectiveness of bevacizumab + oxaliplatine-based chemotherapy regimen (Ox-CT) or FOLFIRI in first-line treatment of KRAS wild-type mCC in comparison to cetuximab + Ox-CT or FOLFIRI and panitumumab + Ox-CT. A Network meta-analysis was conducted to compare these treatments. A constant hazard ratio was used according to the Transparency Committee assessment. Costs were estimated with French databases and were expressed in 2016 Euros. Costs were discounted at an annual rate of 4%. A time horizon of 7 years was used. RESULTS: Total costs for the 1st line of treatment (PFS health state) were 32,940€ (bevacizumab + FOLFIRI or Ox-CT), 85,470€ (cetuximab + FOLFIRI), 80,677€ (cetuximab + Ox-CT) and 76,116€ (panituzumab + Ox-CT). On the 7-years’ time horizon, bevacizumab + FOLFIRI or Ox-CT had a total cost of 90,378€, cetuximab + FOLFIRI or Ox-CT had a total cost of 142,907€ and 138,114€. Panitumumab + Ox-CT had a total cost of 133,554€.

Cost minimization results (1st line) were as followed: bevacizumab + FOLFIRI or Ox-CT allowed savings of 52,529€ compared to cetuximab + FOLFIRI, 47,736€ compared to cetuximab + Ox-CT and 43,176€ compared to panitumumab + Ox-CT. Based on the duration of free survival (1,184 life years) annual costs for the 1st line were 27,826€ for bevacizumab + FOLFIRI or Ox-CT, 72,199€ for cetuximab + FOLFIRI, 68,150€ for cetuximab + Ox-CT and 64,298€ for panitumumab + Ox-CT. CONCLUSIONS:  Bevacizumab is cost-saving in 1st line metastatic colorectal cancer in France. Main savings came from acquisition costs and administrations costs.