Abstract
Purpose
The aim of this study was to evaluate the cost-effectiveness and net monetary benefit
of olaparib maintenance therapy compared with no maintenance therapy after first-line
platinum-based chemotherapy in newly diagnosed advanced BRCA1/2-mutated ovarian cancer from the Italian National Health Service (NHS) perspective.
Methods
We developed a lifetime Markov model in which a cohort of patients with newly diagnosed
advanced BRCA1/2-mutated ovarian cancer was assigned to receive either olaparib maintenance therapy
or active surveillance (Italian standard of care) after first-line platinum-based
chemotherapy to compare cost-effectiveness and net monetary benefit of the 2 strategies.
Data on clinical outcomes were obtained from related clinical trial literature and
extrapolated using parametric survival analyses. Data on costs were derived from Italian
official sources and relevant real-world studies. The incremental cost-effectiveness
ratio (ICER), incremental cost-utility ratio (ICUR), and incremental net monetary
benefit (INMB) were computed and compared against an incremental cost per quality-adjusted
life-year (QALY) gained of €16,372 willingness-to-pay (WTP) threshold. We used deterministic
sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) to assess
how uncertainty affects results; we also performed scenario analyses to compare results
under different pricing settings.
Findings
In the base-case scenario, during a 50-year time horizon, the total costs for patients
treated with olaparib therapy and active surveillance were €124,359 and €97,043, respectively,
and QALYs gained were 7.29 and 4.88, respectively, with an ICER of €9,515 per life-year
gained, an ICUR of €11,345 per QALY gained, and an INMB of €12,104. In scenario analyses,
considering maximum selling prices for all other drugs, ICUR decreased to €11,311
per QALY and €7,498 per QALY when a 10% and 20% discount, respectively, was applied
to the olaparib official price, and the INMB increased to €12,186 and €21,366, respectively.
DSA found that the model results were most sensitive to the proportion of patients
with relapsing disease in response to platinum-based chemotherapy, time receiving
olaparib first-line maintenance treatment, and subsequent treatments price. According
to PSAresults, olaparib was associated with a probability of being cost-effective
at a €16,372 per QALY WTP threshold ranging from 70% to 100% in the scenarios examined.
Implications
Our analysis indicates that olaparib maintenance therapy may deliver a significant
health benefit with a contained upfront cost during a 50-year time horizon, from the
Italian NHS perspective, providing value in a setting with curative intent.
Key words
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Article info
Publication history
Published online: June 23, 2020
Accepted:
April 29,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
