Cost-Effectiveness of Poly ADP-Ribose Polymerase (PARP) Inhibitors in Cancer Treatment: A Systematic Review
Author(s)
Chan VKY1, Yang R2, Li Y3, Wong ICK1, Li X1
1The University of Hong Kong, Hong Kong SAR, Hong Kong, 2The University of Hong Kong, Hong Kong, Hong Kong, 3The University of Hong Kong, Bristol, UK
Presentation Documents
OBJECTIVES:
PARP inhibitors have shown significant improvement in progression-free survival, but their costs cast a considerable financial burden. In line with value-based oncology, it is important to evaluate whether drug prices justify the outcomes. This study aimed to systematically evaluate PARP inhibitors on: 1) cost-effectiveness against standard care, 2) impact on cost-effectiveness upon stratification for genetic characteristics, and 3) identify factors determining their cost-effectiveness, in four cancer types.METHODS:
We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library using designated search terms, updated to 31 August 2021. Trial-based or modelling cost-effectiveness analyses of four FDA-approved PARP inhibitors (olaparib, niraparib, rucaparib and talazoparib) were eligible. Other studies known to authors were included. Reference lists of selected articles were screened. Eligible studies were assessed for methodological and reporting quality before review. RESULTS: A total of 20 original articles proceeded to final review. PARP inhibitors were not cost-effective as recurrence maintenance in advanced ovarian cancer despite improved performance upon genetic stratification. Cost-effectiveness was achieved when moved to upfront maintenance in a new diagnosis setting. Limited evidence indicated non-cost-effectiveness of PARP inhibitors in metastatic breast cancer. The cost-effectiveness of PARP inhibitors in metastatic pancreatic cancer and metastatic prostate cancer remained controversial. Stratification by genetic testing was highly important given the plummeting ICER values when compared to the ‘treat-all’ strategy. Drug cost was a strong determinant for cost-effectiveness in most models.CONCLUSIONS:
In advanced ovarian cancer, the use of PARP inhibitors use should be prioritized for upfront maintenance, and for patients with BRCA mutation or BRCAness at recurrence. Additional economic evaluations are warranted for novel indications in other cancer types.Conference/Value in Health Info
2022-11, ISPOR Europe 2022, Vienna, Austria
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EE139
Topic
Economic Evaluation, Health Policy & Regulatory, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Literature Review & Synthesis, Pricing Policy & Schemes
Disease
SDC: Oncology, STA: Drugs, STA: Personalized & Precision Medicine