# Nationwide Survival Impact of Bevacizumab Under National Reimbursement for Advanced Cervical Cancer in South Korea

## TL;DR

Adding bevacizumab to chemotherapy significantly improves survival in advanced cervical cancer patients in South Korea after national insurance coverage.

## Contribution

This study shows that national reimbursement of bevacizumab leads to improved survival outcomes in real-world clinical practice for advanced cervical cancer.

## Key findings

- Bevacizumab improved median overall survival from 1.5 to 2.5 years in advanced cervical cancer patients.
- Patients with prior chemoradiation therapy benefited most from bevacizumab, regardless of cancer subtype.
- National insurance coverage of bevacizumab was associated with a 41.4% 5-year survival rate.

## Abstract

This study demonstrates that the addition of bevacizumab to chemotherapy improves overall survival in 2792 patients with advanced cervical cancer following the implementation of national insurance reimbursement, using data from the South Korean nationwide cohort. The findings suggest that bevacizumab offers a pronounced survival benefit, particularly for patients with a history of prior concurrent chemoradiation therapy, regardless of histologic subtype, highlighting the clinical value of reimbursement for high-cost novel cancer drugs in real-world practice.

Background: The aim of this study was to evaluate the effectiveness of bevacizumab in advanced cervical cancer (CC) patients using nationwide data after its inclusion in South Korea’s National Health Insurance (NHI), considering various clinicopathologic factors. Methods: This retrospective study analyzed 3869 advanced CC patients from South Korea’s cancer registry (2012–2019), alongside claims and death records (2012–2021). Among these 2792 patients diagnosed after bevacizumab’s NHI inclusion (August 2015), survival outcomes were compared between those receiving bevacizumab with platinum-based chemotherapy (n = 1787, 64.0%) versus chemotherapy alone (n = 1005, 36.0%). Overall survival (OS) was assessed using Cox proportional hazard regression with inverse probability of treatment weighting. Results: Following NHI coverage of bevacizumab, median OS increased from 1.5 to 2.5 years, and the 5-year OS rate increased from 25.6% to 41.4% (weighted hazard ratio [wHR], 0.63; 95% confidence interval [CI], 0.60–0.67). Among patients receiving bevacizumab, median OS was 2.6 years compared to 2.2 years for those not receiving bevacizumab, with 5-year OS rates of 42.0% and 40.2%, respectively (wHR, 0.84; 95% CI, 0.78–0.90). Subgroup analyses revealed that bevacizumab was associated with significantly better OS in patients with prior concurrent chemoradiation therapy (CCRT) history (wHR, 0.67; 95% CI, 0.61–0.75), regardless of histologic subtype (squamous cell carcinoma [SCC]: wHR, 0.69 [95% CI, 0.61–0.78] vs. non-SCC: wHR, 0.66 [95% CI, 0.55–0.79]). Conclusions: The national investment in the implementation of bevacizumab was associated with favorable survival outcomes in advanced CC patients. Particularly, bevacizumab showed pronounced survival benefit for patients with prior CCRT history, regardless of histologic subtype.