Even hefty reductions in the prices won’t make the maintenance therapies cost-effective for patients.
The US Food and Drug Administration approved the maintenance therapies for ovarian cancer patients to improve the survival rate after first-line treatment. However, there are significant costs associated with the application of these strategies for many eligible patients.
These maintenance therapies use PARP-inhibitors which are surely exceptionally efficient in extending the life of ovarian cancer patients. Extensive research has shown that Niraparib is an effective maintenance strategy in advanced, primary epithelial ovarian cancer patients following treatment. Similarly, Olaparib has been studied for patients having BRCA mutated ovarian cancer. Although these treatments have got FDA approval the substantial associated cost has become a huge constraint in providing these treatments to the majority of the eligible patients.
Courtney A. Penn of Cedars-Sinai Medical Center in Los Angeles and colleagues have thoroughly analyzed these maintenance therapies concerning their cost. And they have concluded that even if the therapy is provided free of cost to the specific group of patients, it cannot be considered cost-effective in comparison with patients getting no maintenance therapy. The author wrote,
“Currently available frontline maintenance therapies for advanced, epithelial ovarian cancer cannot be considered cost-effective using a WTP (willingness-to-pay) threshold of $100 000/PF-LYS (progression-free life-year saved). “
Study Design
The research team studied the cost-effectiveness of the maintenance methods after first-line ovarian cancer therapy of primary epithelial ovarian cancer patients. The analysis studied patients with,
- “Base Case 1”: a BRCA variant
- “Base Case 2”: homologous recombination deficiency without a BRCA variant
- “Base Case 3”: homologous recombination proficiency
In “Base Case 1”, 5 maintenance strategies, olaparib, olaparib-bevacizumab, bevacizumab, niraparib including no maintenance strategy assessed in patients with a BRCA variant.
In “Base Cases 2 and 3”, 4 possible maintenance strategies olaparib-bevacizumab, bevacizumab, niraparib, including no maintenance therapy were assessed in patients after ovarian cancer treatment.
Cost-wise Comparison of Maintenance Strategies
The online study published in JAMA Network Open showed that,
- Olaparib (Lynparza) was the most effective maintenance strategy in patients with a BRCA variant with $186,777 per progression-free life-year saved. And to make this therapy this much cost-effective, the third-party payer price needs to be nearly halved. As the researchers wrote,
“….olaparib monotherapy in base case 1 (BRCA variant) became cost-effective at the WTP threshold when the average wholesale acquisition price of olaparib was reduced 47% from $16 999 to approximately $8950 per month”
- Olaparib plus bevacizumab (Avastin) was the most cost-effective therapy in patients with homologous recombination deficiency without a BRCA gene variant. And the total cost assessed was $629,347 per progression-free life-year saved. In this case, the current monthly cost needs to be reduced by more than 85%.
“olaparib-bevacizumab therapy could be considered cost-effective if the average monthly price of both drugs was reduced from $22 249 to $3230, an 85% decrease from current pricing”
Else, the combo of olaparib-bevacizumab therapy must provide an incredibly efficient increase in the survival time of the patient in comparison with the provision of no maintenance therapy.
“Alternatively, olaparib-bevacizumab would need to have a 10.4-year progression-free survival advantage compared with no maintenance—a 6.3-fold increase from its current 1.7-year progression-free survival advantage—to be considered cost-effective at current pricing.”
- bevacizumab was the most cost-effective maintenance therapy in patients with homologous recombination proficiency. And the total cost assessed was $557,865 per progression-free life-year saved.
With a thorough examination of the cost-effectiveness of all these maintenance therapies, Penn and co-authors wrote that even if niraparib is provided free of charge, it is not a cost-effective therapy as compared to no maintenance therapy for patients with homologous recombination proficiency. And this is the population for which the FDA has approved niraparib therapy. She wrote,
“At current costs, niraparib could be considered cost-effective if the progression-free survival advantage compared with no maintenance was 24.5 years, a 108.7-fold increase from the current progression-free survival advantage of 0.23 years,” and “At a cost of $0 per month, niraparib—the maintenance drug currently approved by the FDA for the homologous recombination proficient population—could not be considered cost-effective compared with no maintenance in this population”
Although these maintenance strategies have proved beneficial for ovarian cancer patients in improving progression-free survival, still thorough and detailed investigation of these methods is still necessary before using them in clinical settings.
