{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T18:39:18Z","timestamp":1777919958107,"version":"3.51.4"},"reference-count":48,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Global Oncology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> Using a disaggregated societal perspective and lifetime horizon, a Markov model was developed for estimating the costs and health outcomes in a hypothetical cohort of 1,000 patients with advanced and metastatic cervical cancer treated with either standard chemotherapy alone or in combination with bevacizumab. Effectiveness data for each of the treatment regimen were assessed using estimates from Gynecologic Oncology Group 240 trial. Data on disease-specific mortality in metastatic cervical cancer, health system cost, and out-of-pocket expenditure were derived from Indian literature. Multivariable probabilistic sensitivity analysis was undertaken to account for parameter uncertainty. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> Over the lifetime of one patient with advanced and metastatic cervical cancer, bevacizumab along with standard chemotherapy results in a gain of 0.275 (0.052-0.469) life-years (LY) and 0.129 (0.032-0.218) quality-adjusted life-years (QALY), at an additional cost of $3,816 US dollars (USD; 2,513-5,571) compared with standard chemotherapy alone. This resulted in an incremental cost of $19,080 USD (7,230-52,434) per LY gained and $34,744 USD (15,782-94,914) per QALY gained with the use of bevacizumab plus standard chemotherapy. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Addition of bevacizumab to the standard chemotherapy is not cost effective for the treatment of advanced and metastatic cervical cancer in India at a threshold of 1-time per-capita gross domestic product. <\/jats:p><\/jats:sec>","DOI":"10.1200\/go.21.00355","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T19:59:53Z","timestamp":1647287993000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":8,"title":["Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India\u2014A Model-Based Economic Analysis"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-2631","authenticated-orcid":false,"given":"Nidhi","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prerika","family":"Nehra","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akashdeep Singh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikita","family":"Mehra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adyar Cancer Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-4751","authenticated-orcid":false,"given":"Ashish","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Christian Medical College, Vellore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-842X","authenticated-orcid":false,"given":"Manjunath Nookala","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha","family":"Rajsekhar","sequence":"additional","affiliation":[{"name":"Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9776-6920","authenticated-orcid":false,"given":"Jayachandran Perumal","family":"Kalaiyarasi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adyar Cancer Institute, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Partha Sarathi","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B. Booroah Cancer Institute, Guwahati, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0205-8559","authenticated-orcid":false,"given":"Prabhat Singh","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anisha","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1198-8491","authenticated-orcid":false,"given":"Pankaj","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amal Chandra","family":"Kataki","sequence":"additional","affiliation":[{"name":"Department of Gynaecologic Oncology, Dr B. Booroah Cancer Institute, Guwahati, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7942-1796","authenticated-orcid":false,"given":"Jyoti","family":"Dixit","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6742-6378","authenticated-orcid":false,"given":"Sudeep","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Centre, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lalit","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7719-6986","authenticated-orcid":false,"given":"Shankar","family":"Prinja","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70211-5"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1200\/GO.20.00654"},{"key":"b4","volume-title":"SEER Cancer Statistics Review, 1975-2003","author":"Ries L","year":"2006"},{"key":"b5","first-page":"4837","volume":"17","author":"Jayant K","year":"2016","journal-title":"Asian Pac J Cancer Prev"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1016\/j.currproblcancer.2018.01.016"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.02.027"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1309748"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2014.11.003"},{"key":"b10","volume-title":"Health Technology Assessment in India: A Manual","author":"Department of Health Research, Ministry of Health and Family Welfare, Government of India","year":"2018"},{"key":"b11","volume-title":"Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis","author":"Tan-Torres Edejer T","year":"2003"},{"key":"b12","volume-title":"HTAIn Manual","author":"Health Technology Assessment in India (HTAIn)"},{"key":"b14","unstructured":"Registrar General & Census Commissioner of India: SRS based abridges life tables 201317. https:\/\/censusindia.gov.in\/Vital_Statistics\/SRS_Life_Table\/SRS%20based%20Abridged%20Life%20Tables%202013-17.pdf"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238291"},{"key":"b16","volume-title":"Standard Treatment Guidelines"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31607-0"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.1016\/j.orhc.2019.04.001"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048513"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2020.21.9.2639"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.19.00293"},{"key":"b23","volume-title":"CGHS Rate List","author":"Central Government Health Scheme"},{"key":"b25","volume-title":"Drugs, Surgical and Sutures"},{"key":"b26","volume-title":"Avastin 100 mg Injection: View Uses, Side Effects, Price and Substitutes"},{"key":"b27","doi-asserted-by":"publisher","DOI":"10.4103\/jncd.jncd_49_17"},{"key":"b28","volume-title":"India GDP Deflator | 2005-2021 Data | 2022-2023 Forecast | Historical | Chart | News"},{"key":"b29","volume-title":"US Dollar to Indian Rupee Spot Exchange Rates for 2020"},{"key":"b30","volume-title":"Summary of Recommendations\u2014ICMR-NIN, 2020","author":"ICMR NIN","year":"2020"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8500500205"},{"key":"b32","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462320000677"},{"key":"b33","volume-title":"Macroeconomics and Health: Investing in Health for Economic Development","author":"Sachs JD","year":"2001"},{"key":"b34","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-198308000-00008"},{"key":"b35","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.10.021"},{"key":"b36","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.21.8909"},{"key":"b37","doi-asserted-by":"publisher","DOI":"10.1210\/er.2003-0027"},{"key":"b38","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29210"},{"key":"b39","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_115_19"},{"key":"b40","doi-asserted-by":"publisher","DOI":"10.1007\/s41669-017-0037-0"},{"key":"b41","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2016-000259"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-7-4"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.2217\/fon.14.276"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032530"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.01.027"},{"key":"b46","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2021.22.6.1921"},{"key":"b47","volume-title":"Avastin (Bevacizumab) Dosage & Dosing in Approved Cancer Types"},{"key":"b48","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2009.09.006"},{"key":"b49","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-15-1346"},{"key":"b50","doi-asserted-by":"publisher","DOI":"10.1023\/A:1018435522475"},{"key":"b51","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30734"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO.21.00355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T20:00:06Z","timestamp":1655496006000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO.21.00355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":48,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1200\/GO.21.00355"],"URL":"https:\/\/doi.org\/10.1200\/go.21.00355","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6]]},"assertion":[{"value":"2021-10-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-14","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2100355"}}