Cost-effectiveness analysis of olaparib and niraparib as maintenance therapy for women with recurrent platinum-sensitive ovarian cancer

Leung, John; Lang, Hui Chu; Wang, Shyh Yau; Lo, Hsueh Fang; Chan, Agnes L. F.

doi:10.1080/14737167.2021.1954506

Cited by 9 publications

(22 citation statements)

References 17 publications

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…Clinical outcomes included progression-free survival (PFS), overall survival (OS), and adverse drug reaction. 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 ].…”

Section: Resultsmentioning

confidence: 99%

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

Ding

He²,

Tong³

et al. 2022

PLoS ONE

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Objectives Poly (ADP-ribose) polymerase inhibitor (PARPi) have become a mainstay for the treatment of BRCA-mutant malignancies. PARPis are likely to be more effective but also bring an increase in costs. Thus, we aimed at evaluating the cost effectiveness of PARPis in the treatment of malignancies. Methods Studies of cost effectiveness of PARPis were searched from PubMed, Web of Science, and Cochrane Library. Key information was extracted from the identified studies and reviewed. Quality of the included studies was evaluated using Quality of Health Economic Studies (QHES) instrument. Modeling techniques, measurement of parameters and uncertainty analysis were analyzed across studies. Interventions and cost-effectiveness results were reported stratified by patient population. Results Among the 25 studies identified, we included 17 on ovarian cancer, 2 on breast cancer, 3 on pancreatic cancer, and 3 on prostate cancer that involved olaparib, niraparib, rucaparib, and talazoparib. All studies had a QHES score of above 75. In the maintenance therapy of ovarian cancer, additional administration of olaparib was cost-effective for newly diagnosed patients after first-line platinum-based chemotherapy but was not cost-effective for platinum-sensitive recurrent patients in majority studies. However, the economic value of other PARPis in ovarian cancer as well as all PARPis in other tumors remained controversial. Cost-effectiveness of PARPi was primarily impacted by the costs of PARPi, survival time, health utility and discount rate. Moreover, genetic testing improved the cost-effectiveness of PARPi treatment. Conclusions PARPi is potentially cost-effective for patients with ovarian, pancreatic, or prostate cancer. Genetic testing can improve the cost-effectiveness of PARPi.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Ding

He²,

Tong³

et al. 2022

PLoS ONE

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“…Regardless of genetic features, the ICERs accounted for 69–90% of the WTP threshold. When restricted to gBRCAmut patients only, the ICERs even dropped to between 28 and 43% of the threshold ( Leung et al, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…ICERs were less sensitive to the costs of chemotherapies, hospital care, general adverse event management, and molecular testing. As for clinical estimates, models were more sensitive to the hazard ratios of PFS or the ratios used to project overall survival, time-receiving maintenance treatment, and utility values at progressive disease state ( Smith et al, 2015 ; Zhong et al, 2018 ; Guy et al, 2019 ; Saito et al, 2019 ; Armeni et al, 2020 ; Barrington et al, 2020 ; Su et al, 2020 ; Wu and Shi 2020 ; Leung et al, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Background: PARP inhibitors have shown significant improvement in progression-free survival, but their costs cast a considerable financial burden. In line with value-based oncology, it is important to evaluate whether drug prices justify the outcomes.Objectives: The aim of the study was to systematically evaluate PARP inhibitors on 1) cost-effectiveness against the standard care, 2) impact on cost-effectiveness upon stratification for genetic characteristics, and 3) identify factors determining their cost-effectiveness, in four cancer types.Methods: We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library using designated search terms, updated to 31 August 2021. Trial-based or modeling cost-effectiveness analyses of four FDA-approved PARP inhibitors were eligible. Other studies known to authors were included. Reference lists of selected articles were screened. Eligible studies were assessed for methodological and reporting quality before review.Results: A total of 20 original articles proceeded to final review. PARP inhibitors were not cost-effective as recurrence maintenance in advanced ovarian cancer despite improved performance upon genetic stratification. Cost-effectiveness was achieved when moved to upfront maintenance in a new diagnosis setting. Limited evidence indicated non–cost-effectiveness in metastatic breast cancer, mixed conclusions in metastatic pancreatic cancer, and cost-effectiveness in metastatic prostate cancer. Stratification by genetic testing displayed an effect on cost-effectiveness, given the plummeting ICER values when compared to the “treat-all” strategy. Drug cost was a strong determinant for cost-effectiveness in most models.Conclusions: In advanced ovarian cancer, drug use should be prioritized for upfront maintenance and for patients with BRCA mutation or BRCAness at recurrence. Additional economic evaluations are anticipated for novel indications.

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Whether and How Disutilities of Adverse Events were Used in the Economic Evaluation of Drug Therapy for Cancer Treatment

Dai

Chang

et al. 2023

PharmacoEconomics

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Background The disutilities of adverse events (AEs) are important inputs for cost-utility analysis (CUA), reflecting the impacts of AEs on health outcomes. Health technology assessment institutions and scholars have proposed recommendations for applying disutility values in economic evaluations. Objectives This study aimed to identify the current use of disutilities of AEs as model parameters in the CUA of cancer drug therapy and to compare the discrepancies between the use of disutilities and published recommendations. Methods A systematic search was conducted on the PubMed, Web of Science, and Cochrane Library databases, as well as the official websites of the National Institute for Health and Care Research (NIHR), the Institute for Clinical and Economic Review (ICER), the Institute for Quality and Efficiency in Health Care (IQWiG), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the Centre for Reviews and Dissemination (CRD) for CUAs of drug therapy for cancer published in English from January 2019 to April 2022. Information about the use of disutilities of AEs (whether and how disutilities were used, or why they were not used) in selected studies was extracted and compared with published recommendations. Descriptive analyses were used to summarize the results. Results A total of 467 CUAs were included, 54% (254/467) of which included disutilities of AEs in their model. The proportion that included these disutilities increased from 2019 to 2021, ranging from 47% (51/107) to 61% (116/190). Only 6% (15/254) of the CUAs using disutilities of AEs considered all five recommendations about the justification for inclusion and exclusion, description of values and sources, grades of AEs, calculation, and uncertainty analyses. Only 15% (72/467) provided a clear justification for inclusion and exclusion of disutilities of AEs, and 7% (17/254) did not provide values or sources. In total, 69% (175/254) of the analyses focused on AEs of grade 3 or greater, and 11% (28/254) applied utility decrements for grades 1 and 2. Disutilities of AEs were generally calculated using the incidence rates, which were clearly stated in 49% (65/132) of the analyses. Uncertainty analyses were conducted in 84% (214/254) of the CUAs. Conclusions The current use of disutilities of AEs in CUAs shows some discrepancies with recommendations proposed in the literature. One is that detailed information about the use of disutilities of AEs was not reported and the other is that essential methods to analyze the impact of AEs on quality-adjusted life-years were not thoroughly conducted. Therefore, it is suggested that researchers should attach importance to the impact of AEs on health-related quality of life. Furthermore, an application process was developed for the disutilities of AEs to remind and guide researchers to correctly use the disutilities of AEs as parameters in the decision-analytic model...

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Cost-effectiveness analysis of olaparib and niraparib as maintenance therapy for women with recurrent platinum-sensitive ovarian cancer

Cited by 9 publications

References 17 publications

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

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

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

Whether and How Disutilities of Adverse Events were Used in the Economic Evaluation of Drug Therapy for Cancer Treatment

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