IMMUNOELECTROPHORETIC ANALYSIS

Abstract

<h3>Objectives</h3> (1) To determine whether use of a PARP inhibitor or (2) <i>BRCA1/2</i> mutation testing followed by a PARP inhibitor for test positives is potentially cost-effective for maintenance treatment of platinum-sensitive recurrent high-grade serous ovarian cancer. <h3>Methods</h3> A modified Markov decision analysis compared 3 strategies: (1) observe; (2) olaparib to progression; (3) <i>BRCA1/2</i> mutation testing; treat mutation carriers with olaparib to progression. Progression-free survival and rates of adverse events were derived from a phase 2 randomized trial. Key assumptions are as follows: (1) 14% of patients harbor a <i>BRCA1/2</i> mutation; (2) progression-free survival of individuals treated with olaparib is improved for <i>BCRA1/2</i> carriers compared with noncarriers (estimated hazard ratio, approximately 0.4). Costs derived from national data were assigned to treatments, adverse events, and <i>BRCA1/2</i> test. Monte Carlo probabilistic sensitivity analysis was performed. <h3>Results</h3> Global olaparib was the most effective strategy, followed by <i>BRCA1/2</i> testing and no olaparib. <i>BRCA1/2</i> testing had an incremental cost-effectiveness ratio (ICER) of $193,442 per progression-free year of life saved (PF-YLS) compared to no olaparib, whereas global olaparib had an ICER of $234,128 per PF-YLS compared to <i>BRCA1/2</i> testing. At a 52% lower-than-baseline olaparib cost estimate of $3000 per month, <i>BRCA1/2</i> testing became potentially cost-effective compared with observation, with an ICER of $100,000 per PF-YLS. When strategy (1) was removed from the analysis, <i>BRCA1/2</i> testing was the preferred strategy. <h3>Conclusions</h3> The use of maintenance olaparib in women with high-grade serous ovarian cancer is not cost-effective regardless of whether <i>BRCA1/2</i> testing is used to direct treatment. However, <i>BRCA1/2</i> testing is a preferred strategy compared to global maintenance olaparib alone.