Cost-effectiveness of olaparib maintenance therapy when used with and without restriction by <i>BRCA1/2</i> mutation status for platinum-sensitive relapsed ovarian cancer

Cheng, Lie; Wong, Grace Lai–Hung; Chay, Wen-Yee; Ngeow, Joanne; Tan, Yongqiang; Soon, Swee Sung; Aziz, Mohamed Ismail Abdul; Pearce, Fiona

doi:10.1080/14737167.2021.1890587

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…(2018) later expanded the comparison to both olaparib and niraparib and identified their ICERs at $287,000 and $235,000 per PFS-LYS, which dropped only slightly to $197,000 and $226,000 per PFS-LY when restricted to gBRCAmut patients. Consistent findings were noted in the Institute for Clinical and Economic Review Report, two more studies in the United States(Secord et al, 2013; Institute for Clinical and Economic Review 2017;Dottino et al, 2019), and one study in the Singaporean context(Cheng et al, 2021). The Guy group in the United States was one of the two that concluded PARP inhibitors were cost-effective in comparison to observation, with niraparib in both gBRCAmut and wild-type patients giving ICERs at $68,287 and $108,287 per QALY, albeit a questionably high WTP threshold at $150,000(Guy et al, 2019).…”

supporting

confidence: 68%

“…In recurrent advanced ovarian cancer, Secord et al (2013 )concluded that “global olaparib” offered the greatest efficacy but was the costliest. In the United States and Singapore, “global olaparib” was associated with an incremental cost of $234,128 or $105,300 per progression-free life year compared with the BRCA1/2 testing stratification strategy ( Secord et al, 2013 ; Cheng et al, 2021 ). However, compared with observation only, BRCA1/2 testing-directed treatment was still not cost-effective.…”

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%

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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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supporting

confidence: 68%

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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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 ]. 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 ].…”

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

Leung

Lang

Wang

et al. 2021

Expert Review of Pharmacoeconomics & Outcomes Research

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Cost-effectiveness of olaparib maintenance therapy when used with and without restriction by BRCA1/2 mutation status for platinum-sensitive relapsed ovarian cancer

Cited by 8 publications

References 25 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

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

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

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