Cost-effectiveness analysis of olaparib treatment for metastatic castration-resistant prostate cancer with BRCA 1/2 mutations following a new hormonal agent in China

Abstract

Background

The poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor, olaparib has been approved for the treatment of mCRPC in patients with BRCA1/2 mutations who have progressed following prior therapy that included a new hormonal agents. Patients with prostate cancer carrying BRCA gene mutations exhibit a more aggressive disease progression and poorer prognosis, posing challenges for the effectiveness of current treatment options.

Methods

From the perspective of healthcare payers in China, a three-state partition survival model (progression-free survival, progressed disease and death) was constructed to conduct a cost-effectiveness analysis of olaparib versus enzalutamide for the approved indication. The efficacy and safety of olaparib and enzalutamide were obtained from PROfound trial. Cost were from pricing records and the literature. The model was simulated for 10 years with monthly cycles. Costs and health outcomes were discounted by 5%. Sensitivity analyses were conducted to evaluate the robustness of parameters on the results.

Results

In the base-case analysis, the total cost of olaparib was ¥ 101,012, with a total of 1.1576 QALYs gained. The total cost of enzalutamide was ¥ 52,425, with a total of 0.5929 QALYs gained. Compared to enzalutamide, olaparib had an ICER of ¥ 86,043 per QALY, with an increase in total costs of ¥ 48,587 and an increase in QALYs of 0.5647. At a threshold of three times per capita GDP of China (¥ 257,094 in 2022), the probability of olaparib being cost-effective compared to enzalutamide was 99.0%.

Conclusion

From the healthcare payer perspective, olaparib is cost-effective compared to enzalutamide for the treatment of metastatic castration-resistant prostate cancer in patients with BRCA1/2 mutations who have progressed following prior therapy that included a new hormonal agent.