Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.
Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.
Int J Technol Assess Health Care. 2024 Mar 5;40(1):e14. doi: 10.1017/S0266462324000011.
Olaparib targets the DNA repair pathways and has revolutionized the management of metastatic castration resistant prostate cancer (mCRPC). Treatment with the drug should be guided by genetic testing; however, published economic evaluations did not consider olaparib and genetic testing as codependent technologies. This study aims to assess the cost-effectiveness of germline testing to inform olaparib treatment in mCRPC.
We conducted a cost-utility analysis of germline testing-guided olaparib treatment compared to standard care without testing from an Australian health payer perspective. The analysis applied a decision tree to indicate the germline testing or no testing strategy. A Markov multi-state transition approach was used for patients within each strategy. The model had a time horizon of 5 years. Costs and outcomes were discounted at an annual rate of 5 percent. Decision uncertainty was characterized using probabilistic and scenario analyses.
Compared to standard care, testing-guided olaparib treatment was associated with an incremental cost of AU$7,841 and a gain of 0.06 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY. The probability of testing-guided treatment being cost effective at a willingness-to-pay threshold of AU$100,000 per QALY was around 2 percent; however, the likelihood for cost-effectiveness increased to 66 percent if the price of olaparib was reduced by 30 percent.
This is the first study to evaluate germline genetic testing and olaparib treatment as codependent technologies in mCRPC. Genetic testing-guided olaparib treatment may be cost-effective with significant discounts on olaparib pricing.
奥拉帕利针对 DNA 修复途径，彻底改变了转移性去势抵抗性前列腺癌（mCRPC）的治疗方法。药物治疗应通过基因检测指导；然而，已发表的经济评估并未将奥拉帕利和基因检测视为相互依存的技术。本研究旨在评估种系检测在 mCRPC 中指导奥拉帕利治疗的成本效益。
我们从澳大利亚医保支付方的角度，对种系检测指导奥拉帕利治疗与不进行检测的标准治疗进行了成本效用分析。该分析采用决策树表示种系检测或不进行检测的策略。对于每个策略内的患者，采用 Markov 多状态转移方法。模型的时间范围为 5 年。成本和结果以每年 5%的贴现率贴现。使用概率和情景分析来描述决策不确定性。
与标准治疗相比，检测指导的奥拉帕利治疗与 7841 澳元的增量成本和 0.06 个质量调整生命年（QALY）的收益相关。增量成本效益比（ICER）为每 QALY 143613 澳元。在愿意支付每 QALY 100000 澳元的意愿支付阈值下，检测指导治疗具有成本效益的概率约为 2%；然而，如果奥拉帕利的价格降低 30%，则成本效益的可能性增加到 66%。
这是第一项评估 mCRPC 中种系基因检测和奥拉帕利治疗相互依存技术的研究。种系基因检测指导的奥拉帕利治疗可能具有成本效益，奥拉帕利的价格有较大折扣。
