Cost-Effectiveness of Olaparib Plus Bevacizumab First-Line Maintenance in Ovarian Cancer Alongside the PAOLA-1 Trial
Author(s)
Perrier L1, Zarca K2, Cadet T1, Morelle M1, Cropet C1, Burges A3, Cecere SC4, Palacio I5, Polterauer S6, Yoshida H7, Vuylsteke P8, Colombo N9, Nøttrup TJ10, Abdeddaim C11, El-Balat A12, Cinieri S13, Herrero A14, Kaminski MC15, Pujade-Lauraine E16, Durand Zaleski I17, Ray-Coquard I18
1Centre Léon Bérard, Lyon, France, 2DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France, 3Klinikum der Universität München, München, Germany, 4Department of Urology and Gynecology, Division of Clinical Experimental Uro-Gynecological Oncology of The National Cancer Institute IRCCS Fondazione "G. Pascale" and MITO, Napoly, Italy, 5Hospital Central de Asturias, Oviedo, Spain, 6Department of Obstetrics and Gynecology, Medical University of Vienna, Austria, Vienna, Austria, 7Saitama Medical University International Medical Center, Saitama, Japan, 8CHU UCL Namur, UC Louvain Belgium, Namur, Belgium, 9Department of Medicine and Surgery University of Milan-Bicocca Gynecologic oncology Program, European Institute of Oncology IRCCS, Milan, Italy, 10Copenhagen University Hospital, Rigshospitalet, and NSGO, Denmark, Copenhagen, Denmark, 11Centre Oscar Lambret, Lille, France, 12Spital Uster, Frauenklinik, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Klinik für Frauenheilkunde und Geburtshilfe, Uster, Switzerland, 13U.O.C. Oncologia Medica - Ospedale Senatore Antonio Perrino, Brindisi, Italy, 14Hospital Universitario Miguel Servet, Zaragoza, Spain, 15Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France, 16ARCAGY Research, Paris, France, 17URCEco, AP-HP, Hôpital de l’Hôtel Dieu, F-75004, Paris, 75, France, 18Centre Léon Bérard, and University Claude Bernard Lyon I, Lyon and GINECO, France, Lyon, France
Presentation Documents
OBJECTIVES: PAOLA-1 trial demonstrated a significant progression-free survival (PFS) and OS benefit when maintenance olaparib was added to bevacizumab in newly diagnosed advanced ovarian cancer patients with a positive tumor HRD test, leading to a FDA/EMA label in 2020. The aim of this study was to conduct a cost-effectiveness analysis (CEA) based on patient-level data from the PAOLA-1 trial in the HRD-positive population (n=387/806).
METHODS: Patients were randomized 2:1 to olaparib plus bevacizumab or placebo plus bevacizumab. Hospital costs (€2022) were assessed from the French National Health perspective with a 60 month time horizon. Drug costs, including subsequent therapies, were drawn from the case report. Costs were discounted at 2.5% rate. Restricted mean survival time (RMST) were used. Incremental cost-effectiveness ratios (ICERs) in cost per progression free life year gained (PF-LYG) and in cost per life year gained (LYG) were calculated. Uncertainty around ICERs was captured by bootstrap.
RESULTS: Total mean costs per patient were €112,510 (SD: 50,519) in the olaparib plus bevacizumab group and €70,517 (SD: 62,312) in the placebo plus bevacizumab group. Mean progression free survival were 3.375 and 2.058 years respectively, leading to an ICER of €31,885 per PF-LYG. Results were robust at 95%. Mean overall survival were 4.20 in the olaparib plus bevacizumab group (255/387) and 3.875 years in the placebo plus bevacizumab group (132/387). The corresponding ICER (€129,209 per LYG) may be over-estimated due to treatment crossover: >50% of HRD-positive patients received after progression subsequent PARPi in the placebo plus bevacizumab group.
CONCLUSIONS: These results indicated that olaparib plus bevacizumab is deemed to be more effective and more costly as compared to placebo plus bevacizumab in the HRD-positive population. ICER is expected to reduce with further follow-up. ICER calculated using overall survival endpoint should be taken with caution, as crossover adjustment methods have not yet been applied.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE63
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology