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.

Keywords

Cost-effectiveness analysis / Economic evaluation / Partitioned-survival model / Olaparib / Enzalutamide / Metastatic-castration resistant prostate cancer / BRCA mutation

References

[1] World Health Organization (WHO). Estimated age-standardized incidence rates (World) in 2020, China, males, all ages. https://gco.iarc.fr/today/online-analysis-multi-bars.

[2] Zhu Y, Mo M, Wei Y, et al. Epidemiology and genomics of prostate cancer in Asian men. Nat Rev Urol. 2021 https://doi.org/10.1038/s41585-021-00442-8.

[3] Chen R, Ren S, Yiu M, et al. Prostate cancer in Asia: a collaborative report. Asian J. Urol. 2014;1:15–29.

[4] James ND, Clarke NW, Cook A, et al. Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476). Int J Cancer. 2022; 151: 422- 434.

[5] Armstrong AJ, Szmulewitz RZ, Petrylak DP, et al. ARCHES: a randomized, Phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. J Clin Oncol. 2019; 37: 2974- 2986.

[6] Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015; 373: 737- 746.

[7] Shore ND, Laliberté F, Ionescu-Ittu R, et al. Real-world treatment patterns and overall survival of patients with metastatic castration-resistant prostate cancer in the US prior to PARP inhibitors. Adv Ther. 2021; 38: 4520- 4540.

[8] Oh M, Alkhushaym N, Fallatah S, et al. The association of BRCA1 and BRCA2 mutations with prostate cancer risk, frequency, and mortality: a meta-analysis. Prostate. 2019; 79: 880- 895.

[9] Castro E, Romero-Laorden N, del Pozo A, et al. PROREPAIR-B: a prospective cohort study of the impact of germline dna repair mutations on the outcomes of patients with metastatic castration-resistant prostate cancer. J Clin Oncol. 2019; 37: 490- 503.

[10] Castro E, Goh C, Olmos D, et al. Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. J Clin Oncol. 2013; 31: 1748- 1757.

[11] Olaparib was approved in China for men with HRR gene mutated metastatic castration-resistant prostate cancer(mCRPC) whose disease had progressed during previous treatment with enzalutamide,abiraterone or both. https://www.nmpa.gov.cn/zwfw/sdxx/sdxxyp/yppjfb/20210621084907105.html.

[12] de Bono J, Mateo J, Fizazi K, et al. Olaparib for metastatic castration-resistant prostate cancer. N Engl J Med. 2020; 382: 2091- 2102.

[13] Hussain M, Mateo J, Fizazi K, et al. Survival with olaparib in metastatic castrationresistant prostate cancer. N Engl J Med. 2020; 383: 2345- 2357.

[14] ASCO GU. An Exploratory Gene-By-Gene Analysis of Patients with mCRPC Treated with Olaparib in the PROfound Trial; 2021. https://www.urotoday.com/conference-highlights/asco-gu-2021/prostate-cancer/128058-asco-gu-2021-an-exploratory-gene-bygene-analysis-of-patients-with-mcrpc-treated-with-olaparib-in-the-profound-trial.html (2021).

[15] De Bono JS, Matsubara N, Penel N, ASCO GU. Exploratory Gene-By-Gene Analysis of Olaparib in Patients with Metastatic Castration-Resistant Prostate Cancer: PROfound;2021. https://www.urotoday.com/conference-highlights/asco-gu-2021/prostate-cancer/127876-asco-gu-2021-exploratory-gene-by-gene-analysis-of-olaparib-in-patients-with-metastatic-castration-resistant-prostate-cancer-profound.html.

[16] Overview | Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Treated with Docetaxel | Guidance. NICE; 2021. https://www.nice.org.uk/guidance/TA391.

[17] Overview | Enzalutamide for Metastatic Hormone-Relapsed Prostate Cancer Previously Treated with a Docetaxel-Containing Regimen | Guidance. NICE; 2021. https://www.nice.org.uk/guidance/ta316.

[18] Fassler P, Holmstrom S, Engen AV. PCN130 utility weights for skeletal related events in castration resistant prostate cancer. Value Health. 2011; 14: A458.

[19] Beijing Medical Services Price Standards; 2019. http://zyk.bjhd.gov.cn/sjkf/wsyl/201905/t20190515_4318860.shtml.

[20] Shanghai Medical Services Price Standards. http://wsjkw.sh.gov.cn/ylsfbz/index.html; 2017.

[21] Guangzhou Medical Services Price Standards. http://www.gz.gov.cn/gfxwj/sbmgfxwj/gzsylbzj/content/post_5687435.html; 2020.

[22] Chengdu Medical Services Price Standards. http://cddrc.chengdu.gov.cn/cdfgw/c112479/2016-04/06/content_560db5ac065e4e84b7d9c4856918468a.shtml; 2016.

[23] Wuhan Medical Services Price Standards. https://www.qiaokou.gov.cn/xxgk/jbxxgk/qtzdgkwj/jghsf/ylfwsf/; 2021.

[24] Cao H, Wang J, Shi Y. Survey of the advanced cancer Patients'Medical costs in registered hospice care agencies in five provinces and municipalities. Chin. Gen. Pract. 2010;13:3544–3546.

[25] Yan B, Cai Y, Shen Z. Tendency analysis of average hospitalization cost of prostate cancer in China from 2013 to 2016. Chin J Health Statistics. 2018; 35: 359- 361+367.

[26] Zhang Y, Liu S, Li J. Cost-benefit analysis between home and hospital hospice palliative care services for patients with advanced cancer. Chin. Health Econ. 2012; 31:73–74.

[27] Qian Z, Wang Y, Tang Z, et al. Clinical characteristics, treatment pattern, and medical costs associated with metastatic castration-resistant prostate cancer in Chinese tertiary care hospital settings. J Med Econ. 2019; 22: 728- 735.

[28] Hu X, Qu S, Yao X, Li C, Liu Y, Wang J. Abiraterone acetate and docetaxel with androgen deprivation therapy in high-volume metastatic hormone-sensitive prostate cancer in China: an indirect treatment comparison and cost analysis. Cost Eff Resour Allocation. 2019; 17: 27.

[29] Wang Y. Cost-effectiveness analysis of 3 antimicrobial drugs in the treatment of acute urinary tract infections. China Pharm. 2009; 18: 46.

[30] Liu M, Qu S, Liu Y, Yao X, Jiang W. Comparative clinical effects and cost–effectiveness of maximum androgen blockade, docetaxel with androgen deprivation therapy and ADT alone for the treatment of mHSPC in China. J. Comp. Eff. Res. 2019;8:865–877.

[31] Wu T, Yang Y, Du F, et al. Inpatient cost of treating osteoporotic fractures in mainland China: a descriptive analysis. Clin Outcomes Res. 2015: 205 https://doi.org/10.2147/CEOR.S77175.

[32] Xuan J, Yang F, Du X, Zhao J. A cost–utility analysis of degarelix in the treatment of prostate cancer in China. China Health Insur. 2019;57–62.

[33] Xu C, Cai J, Zhuang J, et al. Cost-effectiveness of olaparib, a PARP inhibitor, for patients with metastatic castration-resistant prostate cancer in China and United States. Ann Transl Med. 2022; 10: 830, 830.

[34] Su D, Wu B, Shi L. Cost-effectiveness of genomic test-directed olaparib for metastatic castration-resistant prostate cancer. Front Pharmacol. 2021;11, 610601.

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