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

Mei Zhan, Hanrui Zheng, Yu Yang, Zhiyao He, Ting Xu, Qiu Li, Mei Zhan, Hanrui Zheng, Yu Yang, Zhiyao He, Ting Xu, Qiu Li

Abstract

Objective: 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: BRCA; Markov model; cost effectiveness; olaparib; pancreatic cancer.

Conflict of interest statement

The authors declare they have no conflicts of interest.

© 2020 Zhan et al.

Figures

Figure 1
Figure 1
The Markov model simulated three health states: PFS, PD and death.
Figure 2
Figure 2
(A) Simulate overall survival curve for the Olaparib group and the Placebo group. (B) Simulate progression-free survival curve for the Olaparib group and the Placebo group. (C) Kaplan–Meier curve of overall survival from the POLO study. (D) Kaplan–Meier curve of the progression-free survival curve from the POLO study.
Figure 3
Figure 3
Tornado diagram of one-way sensitivity analysis. This summarizes the results of one-way sensitivity analysis, listing influential parameters in descending order according to their effect on the ICER over the variation of each parameter value.
Figure 4
Figure 4
Cost-effectiveness acceptability curves. Cost-effectiveness acceptability curves show the probability of each treatment strategy being cost-effective at different WTP thresholds.

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