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July 24, 2017. In recent years there have been major shifts in our approach to metastatic disease, but perhaps in no disease site more drastically than metastatic colon CA. As we’ve mentioned before, the current standard of care for metastatic colon CA is FOLFOXIRIB (has it caught on yet?) which has been shown to achieve excellent rates of conversion to completely-resectable disease (28% R0). But at what cost are we achieving this academic endpoint? The overuse of bevacizumab by oncologists has long been cited as a reason for its current >1 billion dollar annual Medicare budget. Statistical analyses standardly use $100-150K per quality-adjusted life year as a reasonable threshold for cost-effectiveness. The price point for the B addition to FOLFOXIRI: $571,240. And that sticker shock is not unique to the U.S. But, hey, annual costs are still less than Lyrica.