Cost-Effectiveness Analysis of Olaparib in Combination with Bevacizumab Compared with Bevacizumab Monotherapy for the First-Line Maintenance Treatment of Homologous Recombination Deficiency-Positive Advanced Ovarian Cancer

Abstract

Background In the PAOLA-1 trial, olaparib plus bevacizumab demonstrated significant clinical benefit following partial or complete response to platinum-based chemotherapy in homologous recombination deficiency (HRD)-positive ovarian cancer. Our study evaluated the cost effectiveness of olaparib plus bevacizumab compared with bevacizumab alone as a maintenance treatment for women in this population. Methods Our model was a cohort-level partitioned survival model with a lifetime horizon from a US healthcare system perspective. Its four health states were progression-free, post first progression, post second progression, and death, modeled using time to first progression (PFS1), second progression (PFS2), and overall survival (OS) from PAOLA-1. We modeled PFS1 through mixture survival modeling, and PFS2 and OS by fitting standard parametric models. Time-on-treatment was sourced directly from PAOLA-1, with treatment capped at 24 months for olaparib and 15 months for bevacizumab. Costs included drug acquisition and administration, adverse events, disease management, biomarker testing, and subsequent treatments. Deterministic and probabilistic sensitivity analyses tested the results. Results Compared with bevacizumab alone, olaparib plus bevacizumab increased quality-adjusted life-years (QALYs; +2.89) and life-years (LYs; +3.43

Cost-effectiveness of PARP inhibitors in malignancies: A systematic review

“…Characteristics of the included studies are shown in presented in S2 Table . Overall, 19 studies were published after June, 2019, including 9 in 2020 [ 22 – 30 ], 7 in 2021 [ 31 – 37 ], and 3 2022 [ 38 – 40 ]. Studies were conducted from the United States (US) (n = 13) [ 16 – 20 , 23 – 28 , 38 , 40 ], China (n = 5) [ 27 , 30 , 32 , 39 , 40 ], Singapore (n = 2) [ 31 , 34 ], Japan [ 21 ], Italy [ 22 ], and Spain [ 33 ].…”

“…Overall, 19 studies were published after June, 2019, including 9 in 2020 [ 22 – 30 ], 7 in 2021 [ 31 – 37 ], and 3 2022 [ 38 – 40 ]. Studies were conducted from the United States (US) (n = 13) [ 16 – 20 , 23 – 28 , 38 , 40 ], China (n = 5) [ 27 , 30 , 32 , 39 , 40 ], Singapore (n = 2) [ 31 , 34 ], Japan [ 21 ], Italy [ 22 ], and Spain [ 33 ]. PARPi evaluated in these studies included olaparib [ 16 – 18 , 20 – 22 , 25 – 28 , 30 – 32 , 34 – 40 ], niraparib [ 18 – 20 , 23 , 26 , 28 ], rucaparib [ 20 , 28 ], talazoparib [ 33 ], and veliparib [ 24 ].…”

“…PARPi evaluated in these studies included olaparib [ 16 – 18 , 20 – 22 , 25 – 28 , 30 – 32 , 34 – 40 ], niraparib [ 18 – 20 , 23 , 26 , 28 ], rucaparib [ 20 , 28 ], talazoparib [ 33 ], and veliparib [ 24 ]. Modeling methods employed included the Markov model (n = 11) [ 16 , 21 , 22 , 24 , 28 , 30 , 32 , 36 , 37 , 39 , 40 ], decision tree model (n = 6) [ 17 – 20 , 23 , 35 ], partitional survival model (n = 7) [ 25 , 27 , 31 , 33 , 34 , 38 ], and the non-Markov alternatives (n = 1) [ 26 ].…”

“…The models were either based on a single trial (n = 19) or multiple clinical trials (n = 6) [ 18 , 20 , 24 , 26 , 28 , 35 ]. Most studies were assessed from the perspective of health care system (n = 10) [ 18 , 22 , 26 , 31 – 33 , 35 , 38 – 40 ], third-party payers (n = 10) [ 17 , 20 , 21 , 23 – 25 , 27 , 28 , 34 , 36 ] and the whole society (n = 3) [ 16 , 19 , 30 ]. Most studies reported a 3% discount rate on the cost and effects, and two studies reported a discount rate of 5% [ 32 , 40 ] and one reported 2% [ 21 ].…”

“…Apart from Wolford et al [ 28 ], all other authors performed uncertainty analysis. Among them, authors from 13 studies conducted one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) [ 16 , 20 – 22 , 26 , 27 , 30 , 32 , 34 , 37 , 39 , 40 ], those from six studies conducted OWSA, PSA and scenario analysis (SA) [ 18 , 25 , 31 , 35 , 36 , 38 ], those from one study conducted OWSA, two-way sensitivity analysis (TWSA) and PSA [ 24 ], those from three studies only conducted OWSA (n = 3) [ 19 , 23 , 33 ], and those from one only performed SA [ 17 ].…”