OBJECTIVES : Niraparib significantly reduces risk of tumor progression or death in patients with recurrent ovarian cancer (ROC) who are in response to platinum-based chemotherapy. This model-based budget impact analysis estimates the financial impact on US Medicare of maintenance treatment for these patients with niraparib compared to olaparib.

METHODS : The model estimates budget impact to Medicare over 3 years treating ROC patients in response to platinum-based chemotherapy with niraparib compared to olaparib in the maintenance setting. The proportion of adult women with ROC eligible for maintenance treatment was estimated using publicly available sources, including The Surveillance, Epidemiology, and End Results database, published clinical trials, and the World Fact Book. The number of patients receiving poly(ADP-ribose) polymerase (PARP) inhibitors (niraparib or olaparib) in any given quarter was estimated as a function of eligible patients and rate of uptake/ discontinuation. Costs in the analysis were those associated with routine monitoring, drugs, treatment-related adverse events, and subsequent treatment.

RESULTS : Assuming that PARP inhibitors are used in 37% to 75% of the eligible patient population over 3 years (depending upon time since market entry and BRCA mutation status), the model estimated 1,690, 4,500, and 5,627 Medicare patients will receive treatment with PARP inhibitors in years 1, 2, and 3. The drug cost per month at the average dose administered in the respective clinical trials was lower with niraparib than with olaparib by $2,044. Treating patients with niraparib as compared to alternate treatment options resulted in estimated cost savings to Medicare of $30,100,815, $103,260,845, and $132,172,166 in years 1, 2, and 3 respectively.

CONCLUSIONS : Results suggest that when factoring in monitoring, adverse events, and the average dose of drug needed to achieve the efficacy administered in clinical trials, use of niraparib as opposed to other treatment options could result in significant cost savings to Medicare.