OBJECTIVES

In Brazil, it is estimated that OC (ovarian cancer) impacts 7/100,000 habitants every year. Until 2019, platinum-based therapies were considered standards of care, and few innovations could significantly reduce disease progression or survival status (PFS). PARPi (Poly ADP-ribose polymerase inhibitors), such as olaparib, has shown to improve PFS by 51% compared to placebo in first-line maintenance scenario. This result was significantly better in homologous-recombination deficiency (HRD+). As new oncology drugs require significant resource allocation, this study aimed at assessing the cost-effectiveness of olaparib as maintenance therapy for women with HRD+ status ovarian cancer in the private setting in Brazil.

METHODS

: 4-state Partitioned Survival Decision analytic model was used to assess maintenance strategies for patients with HRD+ status ovarian cancer: olaparib-bevacizumab (OLA-BEVA) versus bevacizumab (active control). Clinical parameters for modelling were retrieved from PAOLA-1 and SOLO1 trials and comprised: PFS, overall survival, adverse events and rates of discontinuation. Costs considered in the model included: drug acquisition, adverse events, health care resource use and subsequent therapy in the presence of a progression and end-of-life costs. Uncertainty was explored through one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). 5% annual discount rate was applied according to local guidelines.

RESULTS

: The model suggested that OLA-BEVA was associated with reduced costs of progression (R$193k vs R$284k), which impacted significantly overall costs of OC treatment (R$1.29M vs R$1.35M). Such less progression and death rates were associated with better quality-adjusted life years (QALYs) for OLA-BEVA (6.12 vs 4.33), suggesting that OLA-BEVA was dominant. OWSA and PSA, varied at their confidence intervals, confirmed that base case results were robust.

CONCLUSIONS

: For women with OC HRD+, OLA-BEVA was considered a treatment with higher QALY and reduced costs. Its dominance status over BEVA was achieved by reducing OC-related disease progression, which is associated with significant health care resource use and financial expenditures.