Fan Lin, Zhang Yuanyuan, Maguire Peter, Muston Dominic, Monberg Matthew, Earla Jagadeswara Rao, Mihai Adela, Gulati Poonam
Health Economics and Decision Science, Merck & Co., Inc, Rahway, NJ, USA.
Health Economics and Evidence Generation, Wickenstones Ltd, Milton Park, Oxfordshire, UK.
J Mark Access Health Policy. 2022 Jun 8;10(1):2078474. doi: 10.1080/20016689.2022.2078474. eCollection 2022.
The economic impact of adverse events (AEs) for poly (ADP-ribose) polymerase inhibitors (PARPis) in ovarian or breast cancer has not been widely evaluated.
Compare PARPi-related AE management costs from a US payer perspective.
The frequency of treatment-related grade 3-4 AEs was obtained from published clinical trials of PARPis for the treatment of advanced ovarian cancer (AOC), platinum-sensitive recurrent ovarian cancer (PSROC), and metastatic breast cancer (MBC). AE management costs per patient (2020 USD) per treatment course were calculated by multiplying the AE unit costs by the frequency of AEs for each arm of each trial. Sensitivity analyses were conducted according to the lower and upper limits of the 95% confidence interval for AE rates and unit costs, respectively. Scenarios were also performed to explore the uncertainty of outcomes.
Total AE management costs in AOC were: $3,904, olaparib; $5,595, olaparib plus bevacizumab; and $12,215, niraparib. In PSROC, total costs were: $3,894, olaparib; $6,001, rucaparib; and $11,492, niraparib, and in MBC: $3,574, olaparib; and $9,489, talazoparib. Hematological toxicities were the key drivers of AE management costs for PARPis.
The main AEs among PARPis were hematological. Olaparib was associated with lower AE costs compared to other PARPis.
聚（ADP - 核糖）聚合酶抑制剂（PARPis）用于卵巢癌或乳腺癌时不良事件（AEs）的经济影响尚未得到广泛评估。
从美国医保支付方的角度比较PARPi相关不良事件管理成本。
治疗相关3 - 4级不良事件的发生率取自已发表的PARPis治疗晚期卵巢癌（AOC）、铂敏感复发性卵巢癌（PSROC）和转移性乳腺癌（MBC）的临床试验。每个疗程每位患者的不良事件管理成本（2020美元）通过将不良事件单位成本乘以每个试验各治疗组不良事件的发生率来计算。分别根据不良事件发生率和单位成本的95%置信区间的下限和上限进行敏感性分析。还进行了情景分析以探索结果的不确定性。
AOC中不良事件管理总成本分别为：奥拉帕利3904美元；奥拉帕利联合贝伐单抗5595美元；尼拉帕利12215美元。在PSROC中，总成本分别为：奥拉帕利3894美元；芦卡帕利6001美元；尼拉帕利11492美元；在MBC中：奥拉帕利3574美元；他拉唑帕利9489美元。血液学毒性是PARPis不良事件管理成本的主要驱动因素。
PARPis中的主要不良事件为血液学方面的。与其他PARPis相比，奥拉帕利的不良事件成本较低。
