OBJECTIVES: Metastatic castration-resistant prostate cancer (mCRPC) is the most advanced phase of prostate cancer (PCa) and is responsible for most deaths. Through phase III clinical trials, olaparib (ola) and rucaparib (ruca), (poly(adenosine diphosphate–ribose) polymerase inhibitors) have demonstrated improvements in progression-free survival in mCRPC patients with alterations of BRCA1/2 and having progressed on second-generation androgen-receptor pathway inhibitor (ARPI). While improving outcomes, ruca and ola contribute to the ever-growing economic burden of PCa. Cost-effectiveness analyses are needed to estimate their impact and thus optimize resource utilization. Our objective is to evaluate the cost-effectiveness of ola and ruca versus physician’s choice (docetaxel or ARPI) for mCRPC patients with BRCA1/2 mutations in the Canadian healthcare setting.

METHODS: Partitioned survival models were created to represent mCRPC disease after progression on ARPI until death or 5 years. Survival inputs were extracted from PROfound and TRITON3. Ola costs were extracted from the Quebec Health Insurance Board medication list. As ruca is not commercially available in Canada, we hypothesized that it will be priced on par with ola.

RESULTS: Our findings suggest that ruca provides better survival benefit in terms of quality-adjusted life years (QALY) than ola, but at a higher cost (ICER $302,158/QALY). When compared to the docetaxel, ola and ruca provided an additional 0.27 and 0.44 QALY with additional costs of $81,756 and $131,193, resulting in ICERs of $299,022/QALY and $300,196/QALY respectively. When compared to ARPI, ola and ruca demonstrated clinical benefit and ICERs of $565,057/QALY and $416,204/QALY respectively.

CONCLUSIONS: While providing survival benefit to mCRPC patients presenting alterations of BRCA genes, the cost of ola and ruca requires major reductions to be considered cost-effective when analyzed from the Canadian healthcare perspective.