OBJECTIVES: SOLO1 was an international, Phase III, randomised, double-blind, placebo-controlled trial that assessed the efficacy and safety of Olaparib (OLA) versus placebo in patients with newly diagnosed advanced BRCA-mutated ovarian cancer who were in response (complete or partial) following first-line platinum-based chemotherapy. The acquisition cost of new oncology drugs is a concern for payors in emerging markets. This study aimed to evaluate the cost-effectiveness of OLA therapy in this new indication versus routine surveillance (RS) in the Costa Rican population, using national estimates of costs and treatment patterns.

METHODS:

A three-state partitioned survival model was developed to simulate the lifetime (50 years) incremental cost-effectiveness ratio (ICER) of OLA versus RS from a payer perspective. Progression-free survival (PFS) and overall survival (OS) curves were estimated using data from SOLO1 and extrapolated using parametric survival models for Costa Rica. Mortality and morbidity rates for the groups were modelled based on assumptions validated with local clinicians. Health state utilities and adverse event frequencies were obtained from SOLO1 study. Drug costs were provided by the Caja Costarricense de Seguro Social (CCSS) Healthcare resource usage and costs were based on local clinician input and local publications. A 1.5% discount rate was applied to costs and outcomes.

RESULTS: Maintenance treatment with OLA in first line setting after platinum based chemotherapy compared to routine surveillance as currently practiced was associated with an ICER of $37,004. per QALY. This ICER is lower than the WHO-WTP threshold of three times GDP per capita of $37,026 and the willingness-to-pay (WTP) analysis showed an estimated 99% probability to be cost-effective.

CONCLUSIONS: OLA is a cost-effective treatment option for patients with newly diagnosed BRCA-mutated ovarian cancer, who are in response (complete or partial) after first-line platinum-based chemotherapy in Costa Rica