Population Impact of Performing BRCA1/2 Testing to Guide Metastatic Castration-Resistant Prostate Cancer Treatment in Spain
Author(s)
Federico Rojo, MD1, Elena Castro, MD2, David Olmos, MD2, VIRGINIA LOZANO ROSAS, PhD3, Belen Sanz, PhD3, Melissa Kirker, PharmD4, Allison Thompson, PharmD4, Neo Su, PharmD4, Yang Meng, PhD5, Annika Bjerke, MS5, Divya Patil, MS5, Joaquin Mateo, MD6, VIRGINIA LOZANO7.
1Fundación Jiménez Díaz, Madrid, Spain, 2Hospital Universitario 12 de Octubre, Madrid, Spain, 3Pfizer, Madrid, Spain, 4Pfizer, New York, NY, USA, 5Lumanity, Morristown, NJ, USA, 6Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain, 7BARCELONA, Spain.
1Fundación Jiménez Díaz, Madrid, Spain, 2Hospital Universitario 12 de Octubre, Madrid, Spain, 3Pfizer, Madrid, Spain, 4Pfizer, New York, NY, USA, 5Lumanity, Morristown, NJ, USA, 6Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain, 7BARCELONA, Spain.
OBJECTIVES: Poly ADP-ribose polymerase inhibitors [PARPi] have changed the treatment paradigm for metastatic castration-resistant prostate cancer (mCRPC), and currently, BRCA1/2 and HRR genes testing are recommended in clinical guidelines for these patients. Talazoparib (TALA), a PARPi, with enzalutamide (ENZ, an androgen-receptor pathway inhibitor [ARPi]) showed statistically significant benefit over ENZ in the TALAPRO-2 (TP-2) trial. In Spain, TALA with ENZ is currently reimbursed for mCRPC patients with BRCA1/2 mutations (BRCAm). It has been estimated that 10% of mCRPC patients harbour a BRCAm. This study assesses the clinical impact of BRCA1/2 testing for newly diagnosed patients with mCRPC in Spain.
METHODS: Two testing strategies were analysed: no testing (patients received ENZ, abiraterone [ABI] or docetaxel [DOC]); and universal BRCA1/2 testing, where BRCAm patients received TALA with ENZ and non-BRCAm received either ENZ, ABI or DOC. A partitioned survival model informed efficacy. For universal BRCA1/2 testing, overall survival (OS) and radiographic progression-free survival (rPFS) for TALA with ENZ were based on TP-2 for BRCAm patients. For non-BRCAm, the ENZ arm of TP-2 and indirect comparisons for ABI and DOC versus ENZ were used. Life years (LY) and quality-adjusted life years (QALY), were derived from OS, rPFS and health utilities. The outcome of the no-testing strategy was the weighted average of BRCAm and non-BRCAm patients with non-targeted treatments.
RESULTS: The analysis estimated 7,543 newly diagnosed patients of mCRPC in Spain in 2024, of which 754 would be BRCAm. Over a lifetime, universal BRCA1/2 testing would provide 0.25 LY and 0.24 QALY gains per individual versus no testing. For newly diagnosed mCRPC patients, universal BRCA1/2 testing would yield additional 1,909 LYs and 1,793 QALYs over lifetime versus no testing.
CONCLUSIONS: Universal BRCA1/2 testing would result in substantial population-level clinical benefits for mCRPC patients in Spain. Increased testing is needed to ensure access to targeted treatment with PARPi.
METHODS: Two testing strategies were analysed: no testing (patients received ENZ, abiraterone [ABI] or docetaxel [DOC]); and universal BRCA1/2 testing, where BRCAm patients received TALA with ENZ and non-BRCAm received either ENZ, ABI or DOC. A partitioned survival model informed efficacy. For universal BRCA1/2 testing, overall survival (OS) and radiographic progression-free survival (rPFS) for TALA with ENZ were based on TP-2 for BRCAm patients. For non-BRCAm, the ENZ arm of TP-2 and indirect comparisons for ABI and DOC versus ENZ were used. Life years (LY) and quality-adjusted life years (QALY), were derived from OS, rPFS and health utilities. The outcome of the no-testing strategy was the weighted average of BRCAm and non-BRCAm patients with non-targeted treatments.
RESULTS: The analysis estimated 7,543 newly diagnosed patients of mCRPC in Spain in 2024, of which 754 would be BRCAm. Over a lifetime, universal BRCA1/2 testing would provide 0.25 LY and 0.24 QALY gains per individual versus no testing. For newly diagnosed mCRPC patients, universal BRCA1/2 testing would yield additional 1,909 LYs and 1,793 QALYs over lifetime versus no testing.
CONCLUSIONS: Universal BRCA1/2 testing would result in substantial population-level clinical benefits for mCRPC patients in Spain. Increased testing is needed to ensure access to targeted treatment with PARPi.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE610
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Novel & Social Elements of Value
Disease
Oncology