title: PARP inhibitor maintenance therapy for patients with platinum-sensitive recurrent ovarian cancer: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To determine the cost-effectiveness of olaparib, a PARP inhibitor, as maintenance therapy for platinum-sensitive (PS) recurrent ovarian cancer.
  
  
  METHODS
  Two separate decision analysis models compared the cost of observation versus olaparib maintenance therapy in patients with PS recurrent ovarian cancer, one for patients with a germline BRCA1/2 mutation and one for patients with wild-type BRCA1/2. Patients received six cycles of paclitaxel and carboplatin. Drug costs were estimated using 2014-2015 wholesale acquisition costs. The cost of olaparib was estimated at $13,440 per month. Rate of germline BRCA1/2 mutation was estimated at 20%. Progression-free survival was determined from published data. Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) were calculated. A sensitivity analysis estimated the cost at which olaparib would be cost-effective.
  
  
  RESULTS
  We estimated that there were 5549 patients diagnosed with PS recurrent ovarian cancer in the United States annually. The cost of observation in 1110 patients with a BRCA1/2 mutation was $5.5 million (M) versus $169.2M for maintenance therapy with olaparib. The ICER for olaparib maintenance therapy in patients with a BRCA mutation was $258,864 per PF-LYS. If the cost of olaparib was decreased to $2500 per month, the ICER was $49,584. For the 4439 patients with wild-type BRCA, the cost of maintenance therapy was $444.2M; the ICER was $600,552 per PF-LYS.
  
  
  CONCLUSIONS
  For patients with a germline BRCA1/2 mutation, maintenance therapy with olaparib is not cost-effective with an ICER of $258,864 per PF-LYS. To achieve an ICER of less than $50,000, the cost of olaparib should be $2500 or less per month. For wild-type BRCA1/2 patients, maintenance therapy with olaparib is not cost-effective.
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: hjsmith@uabmc.edu.
authors: Haller J
authors: HJ
authors: Smith
authors: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Christen L
authors: CL
authors: Walters Haygood
authors: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Rebecca C
authors: RC
authors: Arend
authors: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Charles A
authors: CA
authors: Leath
authors: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: J Michael
authors: JM
authors: Straughn
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D018095:Germ-Line Mutation; D006801:Humans; D060046:Maintenance Chemotherapy / Q000191:economics / Q000379:methods; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000191:economics / Q000235:genetics; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000235:genetics; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics; D010793:Phthalazines / Q000191:economics / Q000627:therapeutic use*; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use*; D000067856:Poly(ADP-ribose) Polymerase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D010793:Phthalazines; D010879:Piperazines; D000067856:Poly(ADP-ribose) Polymerase Inhibitors; D016190:Carboplatin; D017239:Paclitaxel; C531550:olaparib
keywords: BRCA; Cost-effectiveness; Olaparib; Ovarian cancer; PARP inhibitiors