Cost-Effectiveness and Net Monetary Benefit of Olaparib Maintenance Therapy Versus No Maintenance Therapy After First-line Platinum-based Chemotherapy in Newly Diagnosed Advanced BRCA1/2-mutated Ovarian Cancer in the Italian National Health Service

Purpose: The aim of this study was to evaluate the cost-effectiveness and net monetary benefit of olaparib maintenance therapy compared with no maintenance therapy after first-line platinum-based chemotherapy in newly diagnosed advanced BRCA1/2-mutated ovarian cancer from the Italian National Health Service (NHS) perspective. Methods: We developed a lifetime Markov model in which a cohort of patients with newly diagnosed advanced BR CA1/2-mutated ovarian cancer was assigned to receive either olaparib maintenance therapy or active surveillance (Italian standard of care) after first-line platinum-based chemotherapy to compare cost-effectiveness and net monetary benefit of the 2 strategies. Data on clinical outcomes were obtained from related clinical trial literature and extrapolated using parametric survival analyses. Data on costs were derived from Italian official sources and relevant real-world studies. The incremental cost-effectiveness ratio (ICER), incremental cost-utility ratio (ICUR), and incremental net monetary benefit (INMB) were computed and compared against an incremental cost per quality-adjusted life-year (QALY) gained of (sic)16,372 willingness-to-pay (WTP) threshold. We used deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) to assess how uncertainty affects results; we also performed scenario analyses to compare results under different pricing settings. Findings: In the base-case scenario, during a 50 year time horizon, the total costs for patients treated with olaparib therapy and active surveillance were (sic)124,359 and (sic)97,043, respectively, and QALYs gained were 7.29 and 4.88, respectively, with an ICER of (sic)9,515 per life-year gained, an ICUR of (sic)11,345 per QALY gained, and an INMB of (sic)12,104. In scenario analyses, considering maximum selling prices for all other drugs, ICUR decreased to 11,311 per QALY and (sic)7,498 per QALY when a 10% and 20% discount, respectively, was applied to the olaparib official price, and the INMB increased to (sic)12,186 and (sic)21,366, respectively. DSA found that the model results were most sensitive to the proportion of patients with relapsing disease in response to platinum-based chemotherapy, time receiving olaparib first-line maintenance treatment, and subsequent treatments price. According to PSAresults, olaparib was associated with a probability of being cost-effective at a (sic)16,372 per QALY WTP threshold ranging from 70% to 100% in the scenarios examined. (C) 2020 Published by Elsevier Inc.