Economic Evaluation of Adding Bevacizumab to Chemotherapy for Metastatic Colorectal Cancer (mCRC) Patients in Indonesia

Document Type : Research Articles


1 Department of Pharmacology and Therapy, Faculty of Medicine Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.

2 Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.

3 Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

4 Respira Hospital, Yogyakarta, Indonesia.

5 Center of Financing and Health Insurance, Ministry of Health, Government of Indonesia, Indonesia.

6 Department of Pediatrics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.


Objective: Since 2016, bevacizumab has been widely used to treat metastatic colorectal cancer (mCRC) in Indonesia. Nevertheless, the high cost of bevacizumab has raised the question of whether the therapy is considered cost-effective and should be included in the national health insurance system. This study aimed to assess the cost-effectiveness of bevacizumab plus chemotherapy versus chemotherapy alone for the treatment of mCRC patients. Methods: A Markov model was applied using the perspective of the Indonesian healthcare system to assess cost-effectiveness. The health outcomes were expressed in terms of quality-adjusted life years (QALY) using the validated EuroQoL-5D-5L instrument. Data for medical costs were collected from hospital billings in four hospitals located in three different cities in Indonesia. Meanwhile, data for utility were obtained from interviewing 90 patients who came to the hospital. We compared those mCRC patients who received chemotherapy alone either with FOLFOX or FOLFIRI, versus patients who received the addition of bevacizumab. Results: With the perspective of societal, the incremental cost-effectiveness ratio (ICER) of adding bevacizumab was USD 49,312 per QALY gained using secondary data and USD 28,446 per QALY using real world data. Conclusion: Using either a healthcare or societal perspective, the addition of bevacizumab for mCRC treatment was considered not cost-effective.


Main Subjects

Volume 22, Issue 6
June 2021
Pages 1921-1926
  • Receive Date: 23 March 2021
  • Revise Date: 24 May 2021
  • Accept Date: 19 June 2021
  • First Publish Date: 19 June 2021