Cost-Effectiveness Analysis of Maintenance Olaparib in Patients with Metastatic Pancreatic Cancer and a Germline BRCA1/2 Mutation Based on the POLO Trial

• Main Authors: Zhan M, Zheng H, Yang Y, He Z, Xu T, Li Q
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-12-01
• Series: Cancer Management and Research
• Subjects: cost effectiveness; pancreatic cancer; olaparib; brca; markov model
• Online Access: https://www.dovepress.com/cost-effectiveness-analysis-of-maintenance-olaparib-in-patients-with-m-peer-reviewed-article-CMAR

Mei Zhan,1– 3 Hanrui Zheng,1– 3 Yu Yang,2,4 Zhiyao He,1 Ting Xu,1,3 Qiu Li2,4 1Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2West China Biomedical Big Data Center, Sichuan University, Chengdu, People’s Republic of China; 3West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China; 4Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of ChinaCorrespondence: Ting XuDepartment of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of ChinaEmail [e-mail] LiDepartment of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of ChinaEmail [e-mail]: The phase III POLO trial demonstrated that olaparib as maintenance therapy for metastatic pancreatic cancer patients with a germline BRCA mutation had greater efficacy than placebo, but maintenance olaparib places an economic burden on patients. This study evaluated the cost-effectiveness of olaparib as maintenance therapy based on the POLO trial (NCT02184195).Methods: A three-state Markov model (progression-free survival [PFS], progressive disease [PD] and death) based on data from the POLO trial was used to estimate the incremental cost-effectiveness ratio (ICER) of maintenance olaparib versus placebo for metastatic pancreatic cancer patients with a germline BRCA mutation. The cost was evaluated from the Chinese society’s perspective, and health outcomes were assessed in terms of quality-adjusted life years (QALYs). The primary outcome was the ICER gained in terms of 2019 US$ per QALY. Model robustness was explored with one-way and probabilistic sensitivity analyses.Results: Compared with placebo, maintenance olaparib increased costs by $23,544.35 while gaining 0.69 QALYs, resulting in an ICER of $34,122.25 per QALY. The ICER was far higher than the commonly accepted willingness-to-pay threshold ($28,255.55 per QALY).Conclusion: Compared with placebo, maintenance olaparib for metastatic pancreatic cancer patients with a germline BRCA mutation is not cost-effective in China.Keywords: cost effectiveness, pancreatic cancer, olaparib, BRCA, Markov model