OBJECTIVES: Pancreatic cancer has an annual incidence of 2/10,000 in Canada, with a one-year mortality rate greater than 80%. Olaparib is approved for the maintenance therapy of adult patients with deleterious or suspected deleterious BRCA metastatic pancreatic adenocarcinoma who did not show any progression for at least 16 weeks with a first-line platinum-based chemotherapy regimen. In the absence of an adequately conducted cost-effectiveness analysis in Canada, it is unclear whether the public payers should reimburse olaparib. Therefore, this study's objective was to assess the cost-effectiveness of olaparib versus placebo in metastatic pancreatic cancer patients with a germline mutation.

METHODS: A partitioned survival model (PSM) with a 5-year time horizon was adopted to estimate the costs and effectiveness of using olaparib versus placebo. All the costs were extracted from the public payer's available resources, effectiveness data were obtained from the POLO trial, and Canadian studies were used for utility inputs. Costs and outcomes were discounted by 1.5% annually. Probabilistic sensitivity analyses (PSA) and scenario analyses were performed.

RESULTS: The Incremental cost-effectiveness ratio (ICER) of the olaparib group compared with placebo was $576,003 per QALY. With a willingness to pay (WTP) threshold of $50,000 per QALY, the drug does not achieve acceptable cost-effectiveness. The total costs of olaparib and placebo over five years were $227,147 and $32,497, with overall QALYs of 1.70 and 1.36, respectively. Scenario analyses resulted in ICERs of $447,648, 459,941 and 517,566 per QALY for %0 and 3% discount rates and a 4-year time horizon, respectively. Olaparib was cost-effective in 0% of iterations in PSA using a threshold of $50,000/QALY.

CONCLUSIONS: Olaparib is not cost-effective at the commonly cited threshold of willingness to pay, mainly due to the high price of the medication and insufficient impact on the overall survival of patients with metastatic pancreatic cancer.