Evaluating the cost-effectiveness of current FDA-approved PARP inhibitors for the treatment of recurrent ovarian cancer.

Abstract

5516 Background: Unlike approved IV administered therapies, Medicare is under no obligation to cover prescription medicines. We sought to evaluate the cost-effectiveness of the two FDA-approved orally administered PARP inhibitors (PARPi), olaparib and rucaparib. Methods: A Markov model was created in TreeAge Pro 2015 with nodes in the chain allowing patients to transition through response, hematological complications, non-hematological complications, progression, and death. Separately, the PARP inhibitors were compared with IV administered drugs approved for recurrent ovarian cancers including platinum-based, non-platinum, and bevacizumab-based regimens. Toxicity and mean PFS rates for the different agents were obtained from registration trial data. Costs of IV chemotherapy, managing toxicities, infusions, and supportive care were estimated using 2015 Medicare data. Incremental cost-effectiveness ratios (ICER) were calculated and survival was reported in quality adjusted life months. Results: Platinum-based combinations were the most cost-effective at $1,672/PFS mo as compared to non-platinum agents ($6,688/mo), bevacizumab-containing regimens ($12,482/mo), olaparib ($13,3731/mo), and rucaparib ($14,034/mo). Considering a cost of $114,478 for olaparib and $137,068 for rucaparib prior to progression, costs associated with PARPi were 7.1 to 8.3X more than platinum combinations. To better compare the registration trial data to PARPi data, probability was adjusted to 2nd line for rucaparib, revealing it’s ICERs’ of per month of life added to be $26,997 for bevacizumab, $17,757 for non-platinum, and $79,585 for platinums. Using the adjusted-to-2nd-line probabilities for olaparib, exhibited ICERs were $16,549 for bevacizumab, $25,637 for non-platinums and $72,083 for platinums. Conclusions: The high costs of PARPi were not balanced by costs of infusion and managing toxicities of IV drugs typically associated with lower response rates and shorter PFS in the recurrent space. Balancing incremental clinical benefit with novel therapies remains problematic and could widen disparities among those with limited access to care.