<p>Cost-Effectiveness Analysis of Maintenance Olaparib in Patients with Metastatic Pancreatic Cancer and a Germline BRCA1/2 Mutation Based on the POLO Trial</p>

Abstract

Objective The phase III POLO trial demonstrated that olaparib as maintenance therapy for metastatic pancreatic cancer patients with a germline BRCA mutation had greater efficacy than placebo, but maintenance olaparib places an economic burden on patients. This study evaluated the cost-effectiveness of olaparib as maintenance therapy based on the POLO trial (NCT02184195). Methods A three-state Markov model (progression-free survival [PFS], progressive disease [PD] and death) based on data from the POLO trial was used to estimate the incremental cost-effectiveness ratio (ICER) of maintenance olaparib versus placebo for metastatic pancreatic cancer patients with a germline BRCA mutation. The cost was evaluated from the Chinese society’s perspective, and health outcomes were assessed in terms of quality-adjusted life years (QALYs). The primary outcome was the ICER gained in terms of 2019 US$ per QALY. Model robustness was explored with one-way and probabilistic sensitivity analyses. Results Compared with placebo, maintenance olaparib increased costs by $23,544.35 while gaining 0.69 QALYs, resulting in an ICER of $34,122.25 per QALY. The ICER was far higher than the commonly accepted willingness-to-pay threshold ($28,255.55 per QALY). Conclusion Compared with placebo, maintenance olaparib for metastatic pancreatic cancer patients with a germline BRCA mutation is not cost-effective in China.

Cost-Effectiveness of Poly ADP-Ribose Polymerase Inhibitors in Cancer Treatment: A Systematic Review

“…In particular, Wu and Shi (2020 ) in the United States found that olaparib was cost-effective with an ICER at $191,596 per PFS-QALY, which was below the $200,000 threshold but not the case when modeling was based on overall survival data ($265,290 per QALY). In China, Zhan et al (2020 ) identified an ICER at $34,122 per QALY which did not support cost-effectiveness at the WTP threshold of $28,255, although the ICER drastically dropped to $14,563 per QALY when the drug cost was calculated based on the donation plan for ovarian cancer.…”

“…All the articles performed sensitivity analyses to assess the factors which potentially impacted the cost-effectiveness of PARP inhibitors. Out of 20 studies, 17 highlighted that the drug price was a significant driver of the ICER ( Secord et al, 2013 ; Smith et al, 2015 ; Wallbillich et al, 2016 ; Institute for Clinical and Economic Review, 2017 ; Zhong et al, 2018 ; Dottino et al, 2019 ; Armeni et al, 2020 ; Barrington et al, 2020 ; Gonzalez et al, 2020 ; Muston et al, 2020 ; Penn et al, 2020 ; Su et al, 2020 ; Wu and Shi, 2020 ; Zhan et al, 2020 ; Cheng et al, 2021 ; Leung et al, 2021 ; Olry de Labry Lima et al, 2021 ). In the United States system, to be cost-effective in treating recurrent ovarian cancer among BRCAmut patients, major cost reduction to $3,000–6,400 per cycle was warranted for olaparib, niraparib, and rucaparib, which was up to 76% reduction at the WTP of $100,000 ( Secord et al, 2013 ; Smith et al, 2015 ; Wallbillich et al, 2016 ; Dottino et al, 2019 ).…”

“…In this review, PARP inhibitors could face a radical price cut to as low as $3,000 in order to fulfill the common WTP thresholds at $100,000, but the requirement seems unrealistic since other novel targeted therapies were commonly marketed at $5,000–10,000 per month or higher ( Kaplan, 2017 ). Price negotiation could be an alternative measure as Zhan et al (2020 ) found that olaparib turned out to be cost-effective in metastatic pancreatic cancer despite off-label use if the discounted price approved in ovarian cancer could similarly be applied to pancreatic cancer ( Zhan et al, 2020 ).…”

“…the case when modeling was based on overall survival data ($265,290 per QALY). In China, Zhan et al (2020) identified an ICER at $34,122 per QALY which did not support costeffectiveness at the WTP threshold of $28,255, although the ICER drastically dropped to $14,563 per QALY when the drug cost was calculated based on the donation plan for ovarian cancer.…”

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 ].…”