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The aim of this paper is to compare the cost for managing severe haematological toxicities (HTs: anaemia, neutropenia, thrombocytopenia) in patients with pretreated, relapsed BRCA-mutant positive (+) ovarian cancer (OC) receiving second-line therapy with olaparib or niraparib. As reported for treatment groups of randomized controlled trials, the incidence of anaemia, neutropenia and thrombocytopenia for olaparib (niraparib) was 0.071, 0.432 and 0.062 (0.253, 0.196 and 0.338), respectively. A one-year decision-tree cost-minimization analysis and a three-year budget impact analysis (BIA) were performed from the viewpoint of the Italian National Health Service (INHS). Health care resources funded by the INHS were identified and quantified based on the literature and expert opinion; they were costed via published sources and expressed in 2018 euro (€) amounts on a per-patient basis. One-way sensitivity analysis (OWSA) and scenario analysis tested the robustness of the base case findings. Our results show that the costs for managing anaemia, neutropenia and thrombocytopenia with olaparib (niraparib) are €440.63, €1032.76 and €171.01 (€1568.82, €468.90 and €936.06), respectively. The overall cost for HT management reaches €1644.41 and €2973.78 for olaparib and niraparib, respectively. Overall savings in favour of olaparib is €1329.37. BIA shows that olaparib can save the INHS €2.322m over a three-year timespan. Sensitivity analyses confirm the robustness of the baseline findings. Despite some limitations in our study, the results of the cost-minimization analysis show that olaparib is a safe and cost-saving health care programme for the INHS for the management of HTs in patients receiving second-line therapy for BRCA+ OC.

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are established therapies for previously untreated advanced/metastatic non-small cell lung cancer (NSCLC) EGFR-mutated patients. Osimertinib, a third-generation TKI, has recently received the same first-line indication. This study aims at investigating management costs and potential productivity losses in Italy in this patient setting, given all the available therapeutic options. Two analyses were performed. The first evaluates first-line yearly management costs and potential productivity losses per patient, for each first-line treatment. The second, performed nationally and regionally, models all lines of treatments and costs over a five-year period, through different market-share scenarios – considering osimertinib adoption as new therapy in 60% of patients as the most probable one – and line-switch/mortality probabilities. Using this model, patients’ total months of treatment and development/progression of brain metastases were also analyzed. The first analysis shows that first-line management costs and potential productivity losses are minimized by osimertinib (first-line yearly expenditure of €25.942, 8%-12% less than TKIs). The second analysis, based on a five-year horizon and on all therapy lines, shows that total management costs and potential productivity losses decrease by increasing the adoption of osimertinib as a first-line therapy (€7.4m cumulative lower cost with osimertinib at 60% compared to 0%). Considering the average month of therapy, where results are not affected by the length of the therapy, with osimertinib at 60% on naïve patients, monthly management costs and productivity losses are 10% lower than in the non-osimertinib scenario. In advanced, metastatic EGFR-mutated NSCLC, the use of osimertinib as the first-line treatment could reduce patient management costs and potential productivity losses.

Introduction Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative syndrome and it is the most common hematological malignancy in Western countries. It has a tendency to develop subsequent relapses, so affected patients are likely to undergo more than one line of treatment. Methods Rather than evaluating the cost-effectiveness of individual therapeutic agents, it becomes therefore recommendable for decision-makers to identify an optimal sequencing of such agents. A four-year cost-consequence analysis was conducted, comparing three alternative strategies for the first-line treatment of patients with previously untreated CLL and coexisting conditions: i) obinutuzumab with chlorambucil (Obi-Clb), ii) rituximab with chlorambucil (Rtx-Clb), and iii) ofatumumab with chlorambucil (Ofa-Clb). Only drug costs were considered in the analysis. Results In two trials, median time to next treatment (TTNT) was longer in Obi-Clb (51.1 months) as compared to Rtx-Clb (38.2 months) or to Ofa-Clb (39.8 months). Therefore, during a 48-month time horizon, patients treated with Obi-Clb would maintain on average the first line treatment; on the contrary, patients treated with Rtx-Clb or with Ofa-Clb would receive on average a second line treatment consisting in the majority of cases of ibrutinib monotherapy, or rituximab with idelalisib or rituximab with bendamustine. The sequence using Obi-Clb regimen in first line showed the lower mean cost of treatment: €22,958 over the 48-month time horizon. Sensitivity analyses on a couple of scenarios provided similar conclusions in terms of overall costs. Conclusion Obi-Clb as first-line treatment appears a recommendable strategy in terms of drug costs in the treatment of patients with previously untreated CLL and coexisting conditions.