Olaparib not cost-effective as maintenance therapy for platinum-sensitive, BRCA1/2 germline-mutated metastatic pancreatic cancer

PLoS One. 2024 Apr 4;19(4):e0301271. doi: 10.1371/journal.pone.0301271. eCollection 2024.

Abstract

Objective: To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model.

Methods: Based on data from the POLO trial, published literature and local cost data, we developed a partitioned survival model of olaparib maintenance including full costs for BRCA1/2 germline testing compared to FOLFIRI maintenance chemotherapy and watch-and-wait. We calculated the incremental cost-effectiveness ratio (ICER) for the base case and several scenario analyses and estimated 5-year budget impact.

Results: Comparing olaparib with watch-and wait and maintenance chemotherapy resulted in incremental cost-effectiveness ratios of CHF 2,711,716 and CHF 2,217,083 per QALY gained, respectively. The 5-year costs for the olaparib strategy in Switzerland would be CHF 22.4 million, of which CHF 11.4 million would be accounted for by germline BRCA1/2 screening of the potentially eligible population. This would amount to a budget impact of CHF 15.4 million (USD 16.9 million) versus watch-and-wait.

Conclusions: Olaparib is not a cost-effective maintenance treatment option. Companion diagnostics are an equally important cost driver as the drug itself.

MeSH terms

  • BRCA1 Protein / genetics
  • BRCA2 Protein / genetics
  • Cost-Benefit Analysis
  • Female
  • Germ Cells / pathology
  • Humans
  • Ovarian Neoplasms* / genetics
  • Pancreatic Neoplasms* / drug therapy
  • Pancreatic Neoplasms* / genetics
  • Pancreatic Neoplasms* / pathology
  • Phthalazines / therapeutic use
  • Piperazines*
  • Platinum / therapeutic use

Substances

  • BRCA1 protein, human
  • BRCA1 Protein
  • olaparib
  • Platinum
  • BRCA2 protein, human
  • BRCA2 Protein
  • Phthalazines
  • Piperazines

Grants and funding

This study was partially funded by the Swiss Study Group for Clinical Cancer Research (SAKK, Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study”.