Cost-Effectiveness of Niraparib and Olaparib as Maintenance Therapy for Patients with Platinum-Sensitive Recurrent Ovarian Cancer
| Autor: | Anh Thu Tran, Elizabeth K Nugent, Lixian Zhong, Taylor A. Tomasino, Judith A. Smith |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Oncology
medicine.medical_specialty Indazoles Paclitaxel Cost effectiveness Cost-Benefit Analysis Clinical Decision-Making MEDLINE Pharmaceutical Science Pharmacy Poly(ADP-ribose) Polymerase Inhibitors Piperazines Olaparib 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Piperidines Maintenance therapy Internal medicine medicine Humans 030212 general & internal medicine Progression-free survival Ovarian Neoplasms business.industry Health Policy food and beverages Health Care Costs medicine.disease Progression-Free Survival United States Models Economic chemistry Recurrent Ovarian Cancer 030220 oncology & carcinogenesis Phthalazines Female Platinum sensitive Neoplasm Recurrence Local Ovarian cancer business |
| Zdroj: | Journal of Managed Care & Specialty Pharmacy. 24:1219-1228 |
| ISSN: | 2376-1032 2376-0540 |
| DOI: | 10.18553/jmcp.2018.24.12.1219 |
| Popis: | The recent approval of olaparib and niraparib as maintenance therapy can significantly affect the management of ovarian cancer. Clinical benefits, however, come with trade-offs in adverse events and costs.To evaluate the cost-effectiveness of new ovarian cancer poly-ADP ribose polymerase (PARP) inhibitor therapies, olaparib and niraparib, as maintenance therapy for patients with platinum-sensitive recurrent ovarian cancer.A decision tree model was constructed to evaluate the costs and effectiveness of olaparib and niraparib compared with placebo from a U.S. health care sector perspective. Costs included drug costs and costs of disease monitoring and management of adverse events throughout the treatment course. Costs were estimated from RED BOOK, Medicare reimbursement rates, and the literature and reported in 2017 U.S. dollars. Clinical effectiveness was measured in progression-free survival (PFS) life-years based on clinical trial results (NCT00753545, NCT01874353, and NCT01847274). The incremental cost-effectiveness ratio (ICER) was computed by dividing the incremental cost by the incremental effectiveness.At base case, niraparib was the more effective treatment option with slightly higher PFS, followed by olaparib. The ICERs for niraparib and olaparib compared with common baseline placebo were $235K and $287K per PFS life-year, respectively, with olaparib extended-dominated by niraparib. Both drugs were associated with lower ICERs in patients with a gBRCA mutation than in patients without a gBRCA mutation. One-way sensitivity analysis suggested that drug prices and PFS could affect ICERs significantly, but the ICERs remained above $100K per PFS life-year within the plausible ranges of all parameters. Probabilistic sensitivity analysis suggested that niraparib was associated with higher net benefits compared with placebo only when willingness-to-pay (WTP) values were above $210K per PFS life-year thresholds.PARP inhibitors niraparib and olaparib will extend PFS in platinum-sensitive recurrent ovarian cancer patients but are also associated with high drug acquisition costs. The base case ICERs were around or above $250K per PFS life-year in this model. No formal cost-effectiveness WTP threshold for health technology assessment exists in the United States. At a reference WTP of $100K per PFS life-year, the PARP inhibitors may not be cost-effective options.This study was unfunded. The authors have nothing to disclose. |
| Databáze: | OpenAIRE |
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