Abstract
5559 Background: To estimate the cost-effectiveness of niraparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, compared with routine surveillance (RS), olaparib and rucaparib for the maintenance treatment of patients with recurrent ovarian cancer. Methods: A decision-analytic model estimated the cost per quality-adjusted life-year gained for niraparib versus RS, olaparib and rucaparib from a US payer perspective. Recurrent ovarian cancer patients with or without germline BRCA mutation, who were responsive to their last platinum-based chemotherapy regimen, entered the model (non-gBRCAmut, gBRCAmut). The model had three health states; progression-free disease, progressed disease and dead. For non-gBRCAmut and gBRCAmut, mean progression-free survival (PFS) was estimated for niraparib and RS, and rucaparib using parametric survival distributions based on ENGOT-OV16/NOVA (Niraparib Phase III trial) and ARIEL3 (Rucaparib Phase III trial), respectively. For non-gBRCAmut, olaparib PFS was estimated from Study 19 (Olaparib Phase II trial). For gBRCAmut, a cost-minimisation analysis was conducted versus olaparib. Due to immature overall survival (OS) data in ENGOT-OV16/NOVA and ARIEL3, mean OS benefit was estimated as double the mean PFS benefit for niraparib, olaparib and rucaparib versus RS. Costs included; drug, chemotherapy, monitoring, adverse events, and terminal care. EQ-5D captured quality-of-life. A 3% annual discount rate was used. Results: Treatment with niraparib increased costs and QALYs versus RS, with an incremental cost-effectiveness ratio of $94,186 and $58,804, for non-gBRCAmut and gBRCAmut. Niraparib had lower costs and higher QALYs compared to olaparib and rucaparib in both populations, with a cost difference of -$57,575 and -$60,400 versus olaparib, and a cost difference of -$117,916 and -$261,950 versus rucaparib for non-gBRCAmut and gBRCAmut. Conclusions: These estimates indicate that niraparib was cost-effective compared to olaparib and rucaparib. Additionally, the cost-effectiveness ratio falls within an acceptable range versus RS. Mature OS data is required to validate these results.
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