Objective
To evaluate the cost-effectiveness of olaparib as a maintenance treatment versus routine surveillance (RS) in patients with
BRCA
mutated (
BRCA
m) advanced ovarian cancer (OC) following response to first-line platinum-based chemotherapy in Singapore.
Methods
A 4-health state partitioned survival model was developed to simulate the lifetime (50 years) incremental cost-effectiveness ratio (ICER) of olaparib versus RS from a healthcare payer perspective. Progression-free survival, time to second disease progression, and overall survival were estimated using SOLO-1 data and extrapolated beyond the trial period using parametric survival models. Any patient who remained progression-free at year 7 was assumed to be no longer at risk of progression. Mortality rates were based on all-cause mortality, adjusted based on
BRCA1/2
mutation. Health state utilities and adverse event frequencies were from SOLO-1. Drug costs were from local public healthcare institutions. Healthcare resource usage and costs were from local clinician input and publications. A 3% discount rate was applied to costs and outcomes. Deterministic and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of results.
Results
The base-case analysis of olaparib maintenance therapy versus RS resulted in an ICER of Singapore dollar (SGD) 19,822 per quality-adjusted life-year (QALY) gained. The ICER was most sensitive to variations in the discount rate. PSA demonstrated that olaparib had an 87% probability of being cost-effective versus RS at a willingness-to-pay of SGD 60,000 per QALY gained.
Conclusion
Olaparib has a high potential of being a cost-effective maintenance treatment versus RS for patients with
BRCA1/2
m advanced OC after response to first-line chemotherapy in Singapore.
was rarely performed. Conclusions: The number of recommended HTAPs to set up a reimbursement fee for a procedure in Japan has grown steadily. However, the applications that didn't satisfy criteria for discussion have also increased. Therefore, applicants should consider providing more evidence to demonstrate improved outcomes with the new procedure to enable a successful recommendation by the Health Technology Assessment Sub-committee.
S9about 2%, as compared to about 5% and 25% under-estimation by the Equipercentile and OLS methods, respectively. Findings about variance shrinkage and relationship with clinical covariates obtained from the two datasets were similar to the simulation results. However, at the individual level of prediction, none of the three methods consistently out-performed the others in terms of mean squared error, mean absolute error or intraclass correlation coefficient. CONCLUSIONS: Utility values obtained from the Mean Rank Method accurately shows the distribution features of the observed utilities at the population and group levels. It is advantageous over the Equipercentile method in terms of not requiring complicated smoothing procedures.
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