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

ABSTRACT

Objectives: To determine whether olaparib maintenance therapy, used with and without restriction by BRCA1/2 mutation status, is cost-effective at the population level for platinum-sensitive relapsed ovarian cancer in Singapore.

Methods: A partitioned survival model compared three management strategies: 1) treat all patients with olaparib; 2) test for germline BRCA1/2 mutation, followed by targeted olaparib use in mutation carriers only; 3) observe all patients. Mature overall survival (OS) data from Study 19 and a 15-year time horizon were used and direct medical costs were applied. Sensitivity analyses were conducted to explore uncertainties.

Results: Treating all patients with olaparib was the most costly and effective strategy, followed by targeted olaparib use, and observation of all patients. Base-case incremental cost-effectiveness ratios (ICERs) for all-olaparib and targeted use strategies were SGD133,394 (USD100,926) and SGD115,736 (USD87,566) per quality-adjusted life year (QALY) gained, respectively, compared to observation. ICERs were most sensitive to the cost of olaparib, time horizon and discount rate for outcomes. When these parameters were varied, ICERs remained above SGD92,000 (USD69,607)/QALY.

Conclusions: At the current price, olaparib is not cost-effective when used with or without restriction by BRCA1/2 mutation status in Singapore, despite taking into account potential OS improvement over a long time horizon.

KEYWORDS:

• BRCA1/2 mutation
• cost-effectiveness
• olaparib
• ovarian cancer
• PARP inhibitors
• partitioned survival analysis

Acknowledgments

The authors would like to acknowledge Dr David SP Tan, Dr Soo-Chin Lee and Dr Benedict Yan from the National University Hospital, Singapore, for providing technical input to inform our analyses.

Authors contributions

All authors have made substantial contributions to the development of the manuscript and have approved the final version submitted.

Declaration of interest

LJC, GW, YT, SSS, MIAZ, FP and KN have no relevant financial or other relationships to disclose. WYC has served on an advisory board for AstraZeneca. JN has received research funding from AstraZeneca for BRCA1/2-related research, served on advisory boards for AstraZeneca and Pfizer, and received honorarium from AstraZeneca and Pfizer for speaking on genetic testing in Singapore. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.