Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Department of Oncology, Chenzhou First People's Hospital, Chenzhou, Hunan, 423000, China.
J Ovarian Res. 2023 Aug 21;16(1):168. doi: 10.1186/s13048-023-01257-4.
In 2023, the final PAOLA-1 trial (NCT02477644) survival data were published documenting the benefits of therapy consisting of olaparib plus bevacizumab for patients with advanced ovarian cancer (AOC) as a function of molecular status. In light of these new data, the present study was conducted with the goal of evaluating the cost-effectiveness of olaparib plus bevacizumab for the treatment of the overall AOC patient population and for homologous recombination deficiency (HRD)-positive patients, patients with a breast cancer susceptibility gene (BRCA) mutations, homologous recombination proficiency (HRD)-positive, or patients not harboring BRCA mutations AOC from a US payers perspective.
A Markov state-transition model with a 15-year time horizon was used to evaluate outcomes of patients administered Olaparib plus bevacizumab versus bevacizumab. Life-years (LYs), quality-adjusted LYs (QALYs), and the incremental cost-effectiveness ratio (ICER) values were evaluated in this study in light of a $150,000/QALY of willingness-to-pay (WTP) threshold. The stability of the established model was evaluated through sensitivity analyses.
Relative to bevacizumab alone, Olaparib plus bevacizumab was associated with mean incremental costs and QALYs (LYs) of olaparib plus bevacizumab versus bevacizumab were $293,656 and 1.85 (2.16), $265,668 and 3.34 (4.02), $242,746 and 1.71 (2.06), and $193,792 and 0.97 (1.14) for overall, BRCA mutation-positive, HRD-positive, and HRD-positive BRCA mutation-negative AOC patients, respectively. The corresponding ICER values for these patient subgroups were $158,729 ($136,218), $79,434 ($66,120), $141,636 ($117,747), and $200,595 ($169,733) per QALY (LY) gained Utility value and the price of olaparib were identified in sensitivity analyses as the primary factors influencing these results.
At current pricing levels, maintenance treatment with olaparib plus bevacizumab treatment may represent a cost-effective therapeutic option for BRCA mutations and HRD-positive AOC patients in the USA.
2023 年，PAOLA-1 试验的最终生存数据公布（NCT02477644），记录了奥拉帕利联合贝伐珠单抗治疗晚期卵巢癌（AOC）患者的疗效，这取决于分子状态。鉴于这些新数据，本研究旨在从美国支付者的角度评估奥拉帕利联合贝伐珠单抗治疗 AOC 患者总体人群和同源重组缺陷（HRD）阳性患者、携带乳腺癌易感基因（BRCA）突变患者、同源重组能力正常（HRD）阳性或不携带 BRCA 突变的 AOC 患者的成本效益。
采用 15 年时间范围的马尔可夫状态转移模型，评估奥拉帕利联合贝伐珠单抗治疗与贝伐珠单抗治疗的患者结局。本研究从 15 万美元/QALY 的意愿支付（WTP）阈值出发，评估了生命年（LY）、质量调整生命年（QALY）和增量成本效益比（ICER）值。通过敏感性分析评估了建立模型的稳定性。
与贝伐珠单抗单药治疗相比，奥拉帕利联合贝伐珠单抗治疗与贝伐珠单抗单药治疗相比，平均增量成本和 QALY（LY）分别为奥拉帕利联合贝伐珠单抗治疗和贝伐珠单抗单药治疗的 293656 美元和 1.85（2.16）、265668 美元和 3.34（4.02）、242746 美元和 1.71（2.06）和 193792 美元和 0.97（1.14）。对于 AOC 患者总体人群、BRCA 突变阳性、HRD 阳性和 HRD 阳性 BRCA 突变阴性患者，相应的 ICER 值分别为 158729 美元（136218 美元）、79434 美元（66120 美元）、141636 美元（117747 美元）和 200595 美元（169733 美元）每 QALY（LY）。效用值和奥拉帕利的价格是敏感性分析中影响这些结果的主要因素。
在当前定价水平下，BRCA 突变和 HRD 阳性 AOC 患者维持治疗使用奥拉帕利联合贝伐珠单抗可能是一种具有成本效益的治疗选择。
