Assessing the Relative Budget Impact (BI) of PARP Inhibitor (PARPi) Combination Therapies for Patients with Metastatic Castration Resistant Prostate Cancer (mCRPC) with and Without BRCA1/2 Mutations

Author(s)

Gomez Montero M1, Capone C2, Kroi F1, Wigfield P1, Dalibot C3, Robinson P4
1Cytel, Rotterdam, South Holland, Netherlands, 2Janssen EMEA, Issy-les-Moulineaux, France, 3Janssen France, Issy les Moulineaux, France, 4Janssen EMEA, High Wycombe, UK

OBJECTIVES: Two PARPi have recently been approved in Europe, in combination with abiraterone and prednisone (AAP), for chemotherapy-ineligible mCRPC: niraparib+AAP for BRCA1/2-mutated patients and olaparib+AAP for patients irrespective of mutational status. We estimate the relative BI of these PARPi combinations within their respective licensed indications.

METHODS: An Excel-based model was developed simulating BRCA1/2-mutated and non-BRCA-mutated populations. A prevalence of 0.06% and an incidence of 0.03% for mCRPC patients was assumed, along with 10% of patients harboring a BRCA1/2 mutation. Modelled mCRPC treatments included AAP monotherapy, enzalutamide and olaparib monotherapy. Niraparib+AAP and olaparib+AAP were considered in accordance with their EMA labels, assuming similar reimbursed launch times. Median radiographic progression-free survival and overall survival from pivotal trials were used to estimate pre- and post-progression disease course. Treatment acquisition, administration, medical resource use, adverse event (AE) and diagnostic testing costs were considered over a five-year time horizon, from a French healthcare perspective. A clinician panel validated background treatment uptake and projected substitution by the PARPi combinations.

RESULTS: The overall BI and per-patient BI were estimated at €35.7M and €23,897 for niraparib+AAP , compared to €372.7M and €27,604 for olaparib+AAP, respectively. Despite non-BRCA-mutated patients reflecting 90% of mCRPC patients, they generate over ten-fold increase in BI relative to the BRCA1/2-mutated population. BRCA1/2-mutated and non-BRCA-mutated population AE-related costs were €2.2M and €25.7M, respectively. These findings were consistent across scenario analyses.

CONCLUSIONS: Olaparib+AAP is associated with disproportionately higher healthcare costs compared to niraparib+AAP. Non-BRCA-mutated patients experience a less aggressive disease course compared to BRCA1/2-mutated patients, and are therefore exposed to a longer treatment duration. Uncertain clinical benefit in non-BRCA-mutated patients compounded with a high cost burden, highlights the importance of ensuring PARPi combinations are reserved for those patients at greatest unmet need and the most cost-efficient use of healthcare resources.

Conference/Value in Health Info

2023-11, ISPOR Europe 2023, Copenhagen, Denmark

Value in Health, Volume 26, Issue 11, S2 (December 2023)

Code

EE690

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis

Disease

Oncology

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