Shu Yamin, Liu Yanxin, He Xucheng, Ding Yufeng, Zhang Qilin
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pharmacy, Pengzhou People's Hospital, Pengzhou, China.
Front Pharmacol. 2022 Aug 12;13:818579. doi: 10.3389/fphar.2022.818579. eCollection 2022.
The aim of this study was to investigate the cost-effectiveness of olaparib as the maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation in China. A Markov model was developed to simulate the clinical course of typical patients with ovarian cancer in the SOLO2 trial. The Weibull survival model was employed to fit the Kaplan-Meier progression-free survival and overall survival probabilities of the olaparib and placebo strategies, respectively. The clinical and direct costs data were derived from randomized clinical trials and published reports. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were estimated over a 10-year lifetime horizon. Meanwhile, one-way and probabilistic sensitivity analyses were used to explore the impact of uncertainty on the model's outcomes. Overall, the incremental effectiveness and cost of olaparib versus placebo were 0.56 QALYs and $43,292.92, respectively, resulting in an ICER of $77,620.56/QALY, higher than the willingness-to-pay (WTP) threshold of China ($31,498.70/QALY). The results were sensitive to the cost of olaparib and utility of PFS. Scenario analyses suggested that when the cost of olaparib was reduced by 60%, ICER decreased to $30,611.52/QALY, lower than the WTP threshold of China. The findings from the present analysis suggest that olaparib with a 60% discount as maintenance therapy might be cost effective in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation in China.
本研究旨在探讨奥拉帕利作为中国铂敏感复发性卵巢癌且携带BRCA1/2突变患者维持治疗的成本效益。构建了一个马尔可夫模型来模拟SOLO2试验中典型卵巢癌患者的临床病程。采用威布尔生存模型分别拟合奥拉帕利和安慰剂策略的无进展生存期和总生存期的Kaplan-Meier概率。临床和直接成本数据来自随机临床试验和已发表的报告。在10年的生存期内估计了质量调整生命年（QALY）和增量成本效益比（ICER）。同时，采用单向和概率敏感性分析来探讨不确定性对模型结果的影响。总体而言，奥拉帕利与安慰剂相比，增量效果和成本分别为0.56 QALY和43,292.92美元，导致ICER为77,620.56美元/QALY，高于中国的支付意愿（WTP）阈值（31,498.70美元/QALY）。结果对奥拉帕利的成本和无进展生存期的效用敏感。情景分析表明，当奥拉帕利成本降低60%时，ICER降至30,611.52美元/QALY，低于中国的WTP阈值。本分析结果表明，在中国，对于铂敏感复发性卵巢癌且携带BRCA1/2突变的患者，以60%折扣的奥拉帕利作为维持治疗可能具有成本效益。
