Cost-effectiveness analysis of olaparib as a maintenance monotherapy for patients with newly diagnosed advanced ovarian cancer and a BRCA1/2 mutation: A United States payer perspective

IntroductionDifferent maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and cost-effectiveness analysis to investigate maintenance strategies containing chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenesis therapy for patients with advanced ovarian cancer.Methods and analysisThe search strategy to identify potentially relevant studies will include hand searches in EMBASE, PubMed, Cochrane library and Web of science. The primary outcome is progression-free survival, defined as the date of randomisation to the date of progression or death. The secondary outcome is overall survival (calculated from the time from randomisation to death from any cause), grade 3–4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. Two steps of meta-analysis will be carried out, traditional pair-wise meta-analysis and network meta-analysis. Methodological quality, risk of bias and the strength of evidence from randomised controlled trials (RCTs) will be proposed to assess the quality of RCTs. Heterogeneity, publication bias, subgroup analysis and sensitivity analysis will be explored.Ethics and disseminationThe purpose of our study is to perform a comprehensive efficacy, safety and cost-effectiveness analysis of all maintenance strategies in patients with advanced ovarian cancer. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics approval is not required for network meta-analysis and cost-effectiveness analysis.PROSPERO registration numberCRD42021231814.

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Ultra-radical surgery compared to standard surgical treatment for women with advanced ovarian cancer: a cost-effectiveness analysis

10.22541/au.160616177.75726197/v1 ◽

2020 ◽

Author(s):

Giovanna Bettoli ◽

Andrew Phillips ◽

Sudha Sundar ◽

Carole Cummins ◽

Anish Bali

Keyword(s):

Ovarian Cancer ◽

Cost Effectiveness ◽

Radical Surgery ◽

Advanced Ovarian Cancer ◽

Progression Free Survival ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Effectiveness Analysis

Objective To compare current surgical practice for women with AOC to ultra-radical surgery; to assess whether the new approach would be cost-effective under NICE guidelines of approximately £20,000/QALY. Design Cost-effectiveness analysis. Setting NHS, using data from a variety of sources. Population Patients with advanced ovarian cancer (FIGO stages IIIC-IV). Methods A decision analytic model (microsimulation model) was built to examine the Objective; deterministic and probabilistic sensitivity analyses were used to test the susceptibilities of the baseline model and its assumptions. Main Outcome Measures ICER (incremental cost-effectiveness ratio). Results The standard model yielded an ICER of £5325.06; this is in spite of an associated overall decrease in utility due to predicted increase in surgical mortality. The parameters with the most significant impact on the ICER are the cost of ultra-radical surgery, the utility associated with progression-free survival, and the probability of death from ultra-radical surgery. Conclusions Ultra-radical surgery is cost-effective under NICE willingness-to-pay thresholds of £20000; the costs of ultra-radical surgery are bound to decrease as centres specialise further, and its effectiveness is also likely due to increase with development of newer techniques and more surgical training.

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Cost-effectiveness of olaparib as a maintenance treatment for women with newly diagnosed advanced ovarian cancer and BRCA1/2 mutations in the United States

Gynecologic Oncology ◽

10.1016/j.ygyno.2020.08.013 ◽

2020 ◽

Vol 159 (2) ◽

pp. 491-497 ◽

Cited By ~ 1

Author(s):

Dominic Muston ◽

Robert Hettle ◽

Matthew Monberg ◽

Kimmie K. McLaurin ◽

Wei Gao ◽

...

Keyword(s):

United States ◽

Ovarian Cancer ◽

Cost Effectiveness ◽

Maintenance Treatment ◽

Advanced Ovarian Cancer ◽

The United States ◽

Newly Diagnosed

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At What Cost Does a Potential Survival Advantage of Bevacizumab Make Sense for the Primary Treatment of Ovarian Cancer? A Cost-Effectiveness Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.1075 ◽

2011 ◽

Vol 29 (10) ◽

pp. 1247-1251 ◽

Cited By ~ 115

Author(s):

David E. Cohn ◽

Kenneth H. Kim ◽

Kimberly E. Resnick ◽

David M. O'Malley ◽

J. Michael Straughn

Keyword(s):

Ovarian Cancer ◽

Cost Effectiveness ◽

Bowel Perforation ◽

Advanced Ovarian Cancer ◽

Cost Effective ◽

Primary Treatment ◽

Cost Effectiveness Analysis ◽

Gynecologic Oncology Group ◽

Effectiveness Analysis ◽

The Cost

Purpose To determine whether the addition of bevacizumab to paclitaxel and carboplatin for the primary treatment of advanced ovarian cancer can be cost effective. Methods A cost-effectiveness analysis compared the three arms of the Gynecologic Oncology Group (GOG) 218 study (paclitaxel plus carboplatin [PC], PC plus bevacizumab [PCB], and PCB plus bevacizumab maintenance [PCB+B]). Actual and estimated costs of treatment plus the potential costs of complications were established for each strategy. Progression-free survival (PFS) and bowel perforation rates were taken from recently reported results of GOG 218. Sensitivity analysis was performed for pertinent uncertainties in the model. Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) were estimated. Results For the 600 patients entered onto each arm of GOG 218 at the baseline estimates of PFS and bowel perforation, the cost of PC was $2.5 million, compared with $21.4 million for PCB and $78.3 million for PCB+B. These costs led to an ICER of $479,712 per PF-LYS for PCB and $401,088 per PF-LYS for PCB+B. When the cost of bevacizumab was reduced to 25% of baseline, the ICER of PCB+B fell below $100,000 per PF-LYS. ICERs were not substantially reduced when the perforation rate was equal across all arms. Conclusion The addition of bevacizumab to standard chemotherapy in patients with advanced ovarian cancer is not cost effective. Treatment with maintenance bevacizumab leads to improved PFS but is associated with both direct and indirect costs. The cost effectiveness of bevacizumab in the adjuvant treatment of ovarian cancer is primarily dependent on drug costs.

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