Studies have shown that utilizing a PARP inhibitor in the management of patients with metastatic pancreatic cancer and BRCA1/2 mutation is clinically beneficial. New research published by Wu et al in JNCCN—Journal of the National Comprehensive Cancer Network sought to determine whether such treatment was also cost-effective vs treatment with placebo. The investigators worked to identify patient subgroups with the highest relative cost-effectiveness through models based on efficacy and toxicity data from the Pancreas Cancer Olaparib Ongoing (POLO) trial and measuring it against cost per quality-adjusted life year.
“With the present clinical evidence, olaparib should be prescribed for patients with metastatic pancreatic cancer harboring a germline BRCA1/2 mutation, especially after first-line platinum-based chemotherapy has been successfully completed,” said co-author Lizheng Shi, PhD, of the School of Public Health and Tropical Medicine, Tulane University. “Our economic analysis found that olaparib might be a cost-effective option for patients, particularly if we select for optimal subgroups, such as those who completed at least 16 weeks of continuous first-line platinum-based chemotherapy.”
Co-author Bin Wu, PhD, of Shanghai Jiaotong University in China, also pointed out, “The cost-effectiveness of olaparib as measured by cost-per-quality-adjusted life year is reasonably close to the commonly used willingness-to-pay thresholds. The value of olaparib maintenance would be even more attractive if the price were lower.”
Study Methods and Results
The researchers calculated incremental cost-utility ratios for patients taking maintenance olaparib vs those taking a placebo. Medical costs included drug acquisition, costs attributed to health states, costs for managing adverse effects, and costs for end-of-life care. All were calculated and considered based on 2018 U.S. dollar values.
Modeling suggested that maintenance olaparib would be cost-effective in certain scenarios, using a threshold of $200,000 per quality-adjusted life year gained.
“While there is emerging evidence that precision medicine is relevant to subsets of patients with advanced pancreatic cancer, definitive results to support the cost-effectiveness of maintenance olaparib is lacking,” commented Robert A. Wolff, MD, of the The University of Texas MD Anderson Cancer Center. Dr. Wolff is a member of the NCCN Guidelines® Panel for Pancreatic Adenocarcinoma and was not involved in this study. “Cost-effectiveness analyses of PARP inhibitors used in similar patient populations with recurrent ovarian cancer have been negative. Thus, either improved patient selection for maintenance olaparib or reduced drug costs are likely necessary to establish olaparib as a cost-effective therapy in metastatic pancreatic cancer.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
