Maintenance therapy for ovarian cancer is not cost-effective at current costs in the US, regardless of molecular signature, according to a study published in JAMA Network Open (2020;3[12]:e2028620. doi:10.1001/jamanetworkopen.2020.28620).
Courtney A Penn, MD, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, and colleagues found that while there are trials reporting positive efficacy results for maintenance regimens for women with primary, advanced epithelial ovarian cancer, there are still “pressing economic considerations given the many eligible patients and substantial associated costs.”
In an effort to examine the cost-effectiveness of the US health care sector’s maintenance strategies for patients with primary epithelial ovarian cancer, Dr Penn and colleagues organized a simulation with patients who have primary epithelial ovarian cancer.
Three decision trees were developed based on molecular signature: a BRCA variant; homologous recombination deficiency without a BRCA variant; or homologous recombination proficiency. The maintenance strategies included were olaparib (SOLO-1), olaparib-bevacizumab (PAOLA-1), bevacizumab (PAOLA-1), and niraparib (PRIMA).
Base case 1 assessed olaparib, olaparib-bevacizumab, bevacizumab, and niraparib versus observation of a patient with a BRCA variant. Base case 2 assessed olaparib-bevacizumab, bevacizumab, and niraparib versus observation in a patient with homologous recombination deficiency without a BRCA variant. Base case 3 assessed olaparib-bevacizumab, bevacizumab, and niraparib versus observation in a patient with homologous recombination proficiency.
The main outcomes and measures were incremental cost-effectiveness ratios (ICERs) in US dollars per progress-free life year (PF-LY) saved.
At a willingness-to-pay threshold of $100,000 per PF-LYs, none of the drugs could be considered cost-effective, even when stratified by molecular signatures.
In the case of a patient with a BRCA variant, olaparib was the most cost-effective (ICER, $186,777/PF-LYs). In order to be cost-effective, the third-party payer price per month of olaparib would need to be reduced by approximately $8000.
In the case of a patients with homologous recombination deficiency without a BRCA variant, olaparib-bevacizumab was the most cost-effective (ICER, $629,347/PF-LYs). Lastly in the case of a patient with homologous recombination proficiency, bevacizumab was the most cost-effective (ICER, $557,865/PF-LYs).
“The findings of this study suggest that, at current costs, maintenance therapy for primary ovarian cancer is not cost-effective, regardless of molecular signature,” concluded. Dr Penn and colleagues.
“For certain therapies, lowering the drug price alone may not make them cost-effective,” they added.—Marta Rybczynski
