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Out-of-Pocket Cost-Effectiveness of Frontline Maintenance Strategies for Advanced Ovarian Cancer

March 22, 2021

In comparison with a biomarker-based strategy, first-line niraparib-for-all maintenance therapy is a cost-effective approach for commercially insured patients with advanced ovarian cancer, but not those covered under Medicare, according to a study presented at the 2021 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

“Niraparib is FDA approved as frontline maintenance therapy for advanced-stage ovarian cancer. A recently published study demonstrated that ovarian cancer patients are willing to pay (WTP) $424 per month for an additional 6 months of progress-free survival (PFS) and $6 per month in the PFS benefit if it is only 2 months,” wrote Stephanie Lim, Duke University Medical Center, Durham, NC, and colleagues.

This study aimed to determine whether a niraparib-for-all frontline maintenance therapy approach is cost-effective vs a biomarker-based strategy from a patient out-of-pocket (OOP) cost perspective.

A Markov-based decision model simulating PRIMA trial results was used to evaluate the cost-effectiveness of a niraparib-for-all approach vs niraparib only for deleterious germline/somatic BRCA mutations and homologous recombination deficient-positive tumors.

Cost-effectiveness was reported as the incremental cost-effectiveness ratio (ICER) in USD per quality-adjusted progressions-free months. The median monthly OOP cost of PARP inhibitor maintenance was $43 for commercially insured and $694 for Medicare beneficiaries.

Niraparib-for-all was more costly for both patients with commercial insurance ($638 vs $362) and Medicare ($5841 vs $1029) compared with a biomarker-based strategy. Although, the niraparib-for-all approach was more effective, with a median PFS of 11 months vs 9.6 months with a biomarker-based approach.

For patients with commercial insurance, niraparib-for-all had an ICER of $200 per quality-adjusted progression-free month compared with a biomarker-based strategy. In comparison with a previously published WTP threshold of $424 per quality adjusted progression-free month, niraparib-for-all could potentially be considered cost-effective.

For patients with Medicare, niraparib-for-all had an ICER of $3213 per quality-adjusted progression-free month compared with a biomarker-based strategy and is not considered cost-effective. A monthly OOP cost of $90 or less would render niraparib-for-all cost-effective based on the published WTP threshold.

“These results highlight the stark differences in financial burden on patients depending on their insurance coverage,” Dr Lim and colleagues concluded.—Janelle Bradley

Lim SL, Moss HA, Havrilesky LJ, et al. A novel, out-of-pocket, cost-effectiveness analysis comparing a frontline niraparib-for-all to a biomarker-based strategy in patients with advanced ovarian cancer. Presented at: the virtual 2021 SGO Annual Meeting on Women’s Cancer; March 19-25, 2021.

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