Cost-effectiveness of Maintenance Therapy Based on Molecular Classification Following Treatment of Primary Epithelial Ovarian Cancer in the United States

Penn, Courtney A.; Wong, Melissa S.; Walsh, Christine

doi:10.1001/jamanetworkopen.2020.28620

Cited by 25 publications

(27 citation statements)

References 19 publications

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“…Without applying cost and benefit discounting, Penn et al was the only group that showed negative findings for first-line maintenance with and without adding an antiangiogenic agent. Among the ten strategies composed of olaparib-only, niraparib-only, bevacizumab-only, and olaparib and bevacizumab with and without stratification by genetic characteristics, when compared against observation, the ICERs stayed high in the range from $366,100 to $10,870,576 per PF-LYS ( Penn et al, 2020 ).…”

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%

“…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 ). For newly diagnosed ovarian and metastatic pancreatic cancers, 47 and 50% reduction in olaparib cost for BRCAmut patients was highlighted, respectively ( Penn et al, 2020 ; Wu and Shi, 2020 ). In the Spanish context, for metastatic breast cancer, an even more drastic price cut for talazoparib to $906 per cycle (85% reduction) was warranted to reach the $23,945 threshold ( Olry de Labry Lima 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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“…A study on the cost effectiveness of maintenance therapies showed that none of the maintenance therapies was cost-effective when the patients had to pay for the therapy [116].…”

Section: Current Recommendations For Maintenance Therapymentioning

confidence: 99%

Surgical and systemic therapies for addressing occult disease in advanced epithelial ovarian cancer

Bhatt¹,

Sinukumar²,

Kammar³

et al. 2022

Eur. J. Gynaecol. Oncol.

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The incidence of peritoneal recurrence in advanced epithelial ovarian cancer (EOC) is high and could be attributed to the high prevalence of occult disease the persists despite complete cytoreductive surgery (CRS) and systemic chemotherapy. Several therapeutic approaches have been used to address such occult disease. Hyperthermic intraperitoneal chemotherapy (HIPEC) acts on microscopic disease as well as free intraperitoneal cancer cells shed during surgery, thus, reducing the risk of recurrence. Maintenance therapies like Poly ADP-Ribosyl Polymerase (PARP) inhibitors and the anti-angiogenic agent bevacizumab are used as maintenance therapies to delay recurrence. The most definitive way to eradicate such occult disease completely is resection of the peritoneum. The high preponderance of occult disease in the parietal peritoneum and some regions of the visceral peritoneum has led some surgeons to investigate the role of a total parietal peritonectomy (TPP) performed along with wide resection of the visceral peritoneum as a strategy for addressing occult disease. The mechanism of action differs from that of HIPEC and systemic therapies. It is possible that the benefit of each of these therapies is additive. EOC is a heterogeneous disease with a number of clinicopathological and molecular factors influencing the prognosis. There are likely to be different subgroups of patients that benefit from each of these 4 therapies or a combination of these. In this manuscript, we review the rationale and current evidence for the use of each of these therapies and discuss the potential role of a TPP in light of other therapies.

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“…A cost-effectiveness study on the OVIHIPEC 1 data demonstrated that HIPEC was cost-effective in the Netherlands for this indication [85]. Contrary to this, a study from the USA published in 2020 concluded that none of the maintenance therapies was cost-effective regardless of the molecular signature [86].…”

Section: The Role Of Hipec In Brca-mutated Tumors and Patients Receiv...mentioning

confidence: 99%

Hyperthermic Intraperitoneal Chemotherapy in the Treatment Armamentarium of Epithelial Ovarian Cancer: Time to End the Dichotomy

Bhatt

Gléhen

2022

Visc Med

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Background: Advanced epithelial ovarian cancer (EOC) is an incurable disease with over 75% of the patients developing recurrence in the peritoneum. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment option for both first-line therapy and treatment of recurrence. In this article, we review the rationale and current evidence for performing HIPEC and the role of HIPEC in the light of targeted systemic therapies. Summary: There are few randomized trials and several retrospective studies on the role of HIPEC in the management of EOC. A 12-month-overall survival (OS) benefit of the addition of HIPEC to interval cytoreductive surgery (CRS) was demonstrated in 1 randomized trial following which HIPEC has been included as a treatment option for this indication in several national/international guidelines. One retrospective propensity score-matched analysis showed a 16-month OS benefit of adding HIPEC to primary CRS. One randomized trial showed no benefit of the addition of carboplatin HIPEC to secondary CRS over secondary CRS alone. For patients undergoing primary CRS and secondary CRS for recurrence, the results of ongoing randomized trials are needed to define the role of HIPEC in these situations. All clinical trials have shown that the morbidity of HIPEC performed after CRS is acceptable. Along with the emergence of HIPEC as a promising surgical therapy, targeted therapies like bevacizumab and poly adenosine diphosphate-ribose polymerase inhibitors have been developed that have shown a survival benefit in selected patients. In principle, HIPEC and targeted therapies work in different ways and it is plausible to assume that their benefit could be additive, and their combination should be evaluated in clinical trials. The impact of prognostic factors like the disease extent, pathological response to systemic chemotherapy (SC), the histological subtype and molecular profile on the benefit of HIPEC, and targeted therapies has not been evaluated in clinical trials. Key Messages: HIPEC is an important therapeutic strategy in the treatment of EOC. While its role in patients undergoing interval CRS has been established, the results of ongoing randomized trials are needed to define its benefit at other time points. The morbidity of HIPEC in addition to CRS is acceptable. More research is needed to define subgroups that benefit most from HIPEC based on the extent of disease, response to SC, histology, and molecular profile. The combination of HIPEC and maintenance therapies should be evaluated in well-designed randomized clinical trials that evaluate not just the survival benefit and morbidity but also the cost-effectiveness of each therapy.

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Cost-effectiveness of Maintenance Therapy Based on Molecular Classification Following Treatment of Primary Epithelial Ovarian Cancer in the United States

Cited by 25 publications

References 19 publications

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

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

Surgical and systemic therapies for addressing occult disease in advanced epithelial ovarian cancer

Hyperthermic Intraperitoneal Chemotherapy in the Treatment Armamentarium of Epithelial Ovarian Cancer: Time to End the Dichotomy

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