OBJECTIVES

To evaluate the cost-effectiveness of rucaparib compared to placebo in the setting of advanced ovarian cancer associated with deleterious BRCA mutation with prior responses to at least two platinum-based chemotherapy regimens from a U.S. health system perspective.

METHODS

A partition-survival model was used to compare the cost and efficacy of rucaparib versus placebo based on a phase 3 trial (ARIEL3). The model structure included three health states (progression-free, progression, death) and a Weibull distribution was used to extrapolate survival results beyond the observed time frame of the clinical trial. In the absence of overall survival data from the ARIEL 3 trial, overall survival for rucaparib and placebo was assumed to follow that of another study of a PARP inhibitor, olaparib, versus placebo that involved the same treatment population. The model included direct pharmacy and medical costs, utilized a lifetime horizon, and discounted future costs and outcomes by 3% per year. The primary outcome was an incremental cost-effectiveness ratio (ICER), measured as cost per QALY.

RESULTS

The incremental costs and QALYs for rucaparib versus placebo were $264,989 and 0.73, respectively, yielding an ICER of $361,535/QALY. One-way sensitivity analyses indicated that the ICER was most sensitive to changes in the overall survival hazard ratio for rucaparib versus placebo. A probabilistic sensitivity analysis indicated that approximately 1% of ICERs were below $150,000/QALY.

CONCLUSIONS

With an ICER exceeding the commonly cited thresholds of $100,000/QALY and $150,000/QALY, rucaparib does not appear to be cost-effective in this setting. The results thus do not support the case for wide-scale adoption of this new therapy in the absence of new data to support its value to healthcare decision makers.