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

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.
Competing Interests: All authors have read the journal’s policy and the authors of this manuscript have the following competing interests. AW: no conflicts of interest for this article AS: no conflicts of interest for this article KD: no conflicts of interest for this article TK: no conflicts of interest for this article JL: no conflicts of interest for this article MS: unrelated to the present work, research funding from AbbVie, Biogen, Bristol Myers Squibb, Merck Sharpe & Dohme, Mundipharma, Novartis, and Roche via employment institution; personal fees from Sandoz RvM: consultancy fees from Astra Zeneca, Eili Lilly, Gilead Science, GlaxoSmithKline, Merck, MSD, Novartis, Pierre Fabre, Pharmamar, Sanofi and Vifor. Travel grants from Pierre Fabre, Takeda TM: no conflicts of interest for this article This study was partially funded by Swiss Study Group for Clinical Oncological Research (SAKK, Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung). This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2024 Mehra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)