OBJECTIVES

Evaluate the USA cost-effectiveness of BRCA biomarker testing and treatment with PARP inhibitor maintenance monotherapy in patients with advanced ovarian cancer after response to first-line platinum chemotherapy.

METHODS

A 3-state partitioned survival model was developed to assess the cost-effectiveness of biomarker test and treat with olaparib in BRCA only (1), niraparib in BRCA only (2), olaparib in BRCA and niraparib in non-BRCA (3), and a test-free strategy of niraparib in all patients (4), versus routine surveillance (RS). Progression-free survival, overall survival and BRCA prevalence were modelled on data from PRIMA and SOLO1 trials, the latter adjusted to the higher-risk PRIMA population. A 50-year horizon was adopted, with costs and effects discounted at 3.0%.

RESULTS

Compared to RS, the per patient incremental costs of each strategy was $45,879 (1), $105,149 (2), $218,753 (3), and $276,686 (4) with incremental QALYs of 0.61 (1), 0.52 (2), 1.12 (3), 1.03 (4). The least costly PARP strategy was olaparib in BRCA only (1), which had an incremental cost-effectiveness ratio (ICER) of $75,020 per QALY vs RS. This strategy was both less costly and more effective than niraparib in BRCA only, such that (1) dominated (2). The use of niraparib in non-BRCA alongside olaparib in BRCA (3) led to increased costs and QALYs vs (1), with an ICER of $340,842 per QALY gained. The most expensive PARP strategy of niraparib in all patients (4) was less effective than olaparib in BRCA and niraparib in non-BRCA (3), such that (3) dominated (4).

CONCLUSIONS

At thresholds of $75,020-$340,842 per QALY gained, the optimal cost-effective strategy was testing followed by olaparib in BRCA and RS in non-BRCA (1). Strategies involving niraparib were either dominated (2, 4) or cost-ineffective (3). Biomarker guided treatment is essential to the cost-effective use of PARP inhibitors in this setting.