Methods: We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events and quality of life were considered to be generalizable and therefore identical for all countries. We used country specific prices for medications, administration, and other health service costs. All costs were converted from local currency to US dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties.
Results: Base case results demonstrated that the highest ICER was in the US ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, UK and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY.