image: JNCCN November 2020 Cover
PLYMOUTH MEETING, PA [November 12, 2020] -- Studies have shown that utilizing a PARP inhibitor in the management of patients with metastatic pancreatic cancer who harbor BRCA 1/2 mutations is clinically beneficial [1]. New research in the November 2020 issue of JNCCN--Journal of the National Comprehensive Cancer Network sheds further light on this subject through cost-effectiveness analysis. The investigators seek to identify patient subgroups with the highest relative cost-effectiveness, through models based on efficacy and toxicity data from the Pancreas Cancer Olaparib Ongoing (POLO) trial, and measuring it against cost per quality-adjusted life year (QALY).
"With the present clinical evidence, olaparib should be prescribed for patients with metastatic pancreatic cancer harboring a germline BRCA 1/2 mutation, especially after the first-line platinum-based chemotherapy has been successfully completed," said researcher Lizheng Shi, PhD, School of Public Health and Tropical Medicine, Tulane University. "Our economic analysis found that olaparib might be a cost-effective option for patients, particularly if we select for optimal sub-groups, such as those who completed at least 16 weeks of continuous first-line platinum-based chemotherapy."
Bin Wu, PhD, of Shanghai Jiaotong University in China, who co-authored this study also pointed out: "The cost-effectiveness of olaparib as measured by cost-per-QALY is reasonably close to the commonly used willingness-to-pay thresholds. The value of olaparib maintenance would be even more attractive if the price were lower."
The researchers calculated incremental cost-utility ratios (ICUR) for patients taking maintenance olaparib versus those taking a placebo. Medical costs included drug acquisition, costs attributed to health states, costs for managing adverse effects, and costs for end-of-life care. All were calculated and considered based on 2018 U.S. dollar values. Modeling suggested that maintenance olaparib would be cost-effective in certain scenarios, using a threshold of $200,000 per QALY gained.
"While there is emerging evidence that precision medicine is relevant to subsets of patients with advanced pancreatic cancer, definitive results to support the cost-effectiveness of maintenance olaparib is lacking," commented Robert A. Wolff, MD, The University of Texas MD Anderson Cancer Center. Dr. Wolff is a member of the NCCN Guidelines® Panel for Pancreatic Adenocarcinoma and was not involved in this study. "Cost-effectiveness analyses of PARP inhibitors used in similar patient populations with recurrent ovarian cancer have been negative [2]. Thus, either improved patient selection for maintenance olaparib or reduced drug costs are likely necessary to establish olaparib as a cost-effective therapy in metastatic pancreatic cancer."