Cost-Effectiveness of Niraparib Versus Routine Surveillance, Olaparib and Rucaparib for the Maintenance Treatment of Patients with Ovarian Cancer in the United States

Abstract

Objectives The aim was to evaluate the cost-effectiveness of niraparib compared with routine surveillance (RS), olaparib and rucaparib for the maintenance treatment of patients with recurrent ovarian cancer (OC). Methods A decision-analytic model estimated the cost per quality-adjusted life-year (QALY) gained for niraparib versus RS, olaparib, and rucaparib from a US payer perspective. The model considered recurrent OC patients with or without germline BRCA mutations (g BRCA mut and non-g BRCA mut), who were responsive to their last platinum-based chemotherapy regimen. Model health states were: progression-free disease, progressed disease and dead. Mean progression-free survival (PFS) was estimated using parametric survival distributions based on ENGOT-OV16/NOVA (niraparib phase III trial), ARIEL3 (rucaparib phase III trial) and Study 19 (olaparib phase II trial). Mean overall survival (OS) benefit was estimated as double the mean PFS benefit based on the relationship between PFS and OS observed in Study 19. Costs included: drug, chemotherapy, monitoring, adverse events, and terminal care. EQ-5D utilities were estimated from trial data. Results Compared to RS, niraparib was associated with an incremental cost-effectiveness ratio (ICER) of US$68,287/QALY and US$108,287/QALY for g BRCA mut and non-g BRCA mut, respectively. Compared to olaparib and rucaparib, niraparib decreased costs and increased QALYs, with a cost saving of US$8799 and US$22,236 versus olaparib and US$198,708 and US$73,561 versus rucaparib for g BRCA mut and non-g BRCA mut, respectively. Conclusions Niraparib was estimated to be less costly and more effective compared to olaparib and rucaparib, and the ICER fell within an acceptable range compared to RS. Therefore, niraparib may be considered a cost-effective maintenance treatment for patients with recurrent OC. Electronic supplementary material The online version of this article (10.1007/s40273-018-0745-z) contains supplementary material, which is available to authorized users.

A Critical Appraisal and Recommendations for Cost-Effectiveness Studies of Poly(ADP-Ribose) Polymerase Inhibitors in Advanced Ovarian Cancer

“…This trend was consistent in the abstracts we reviewed but did not score; of the abstracts assessed, two studies included a longer time horizon, with the remaining studies focused on shorter time horizons [18,25]. Only 3 of 18 studies reported discounting outcomes, with two studies reporting a 3% discounting rate and one study reporting a 3.5% discounting rate (QHES item 8) [18,22,25]. All full-text studies met QHES items 4 and 6 (incremental analysis between alternatives).…”

“…1) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Five of the 18 studies were published as full-text articles [17,19,22,26,33] and the remaining were abstracts presented at conferences. The 18 studies identified by the systematic literature review and the key elements of their study designs are summarized in Table 1.…”

“…The majority (n = 14) of the included abstracts and fulltext studies reported the incremental costs per progressionfree life-year (PF LY) gained or per progression-free qualityadjusted life-year (PF QALY) gained [16,17,19,20,23,24,[26][27][28][29][30][31][32][33]. Five studies reported incremental costs per LY or QALY gained [18,21,22,25,29]. The incremental cost per PF LY gain reported for olaparib versus placebo ranged from €63,046 [25] to $600,000 [26], depending on the country, line of therapy, and BRCA mutation status.…”

“…In 16 of the 18 identified studies, model types were described as decision-analytic models [19,20,22,23,26,33], Markov models [16,17,25,[28][29][30][31][32], and a partitioned survival model [18]. For the remaining two studies, one did not report the model structure [27] and the other relied on reported median OS for the CEA and did not estimate life expectancy through simulation or evidence synthesis [21].…”

“…For the remaining two studies, one did not report the model structure [27] and the other relied on reported median OS for the CEA and did not estimate life expectancy through simulation or evidence synthesis [21]. Health states considered in the models were reported in six studies; two of the studies considered three states (progression-free, progressed disease, and death) [18,22], while the other four studies considered five states (response, hematological complications, non-hematological complications, next-line therapy or progression, and death) [28][29][30]32]. Among the five full-text studies, only two (40%) clearly displayed the economic model structure, study methods, and components of the numerator and denominator (QHES item 12) [17,33].…”