Cost-Utility Analysis of Adjuvant Olaparib for Germline BRCA1/2-Mutated, High-Risk HER2-Negative Early Breast Cancer in Spain

Overview

Journal Pharmacoecon Open

Date 2024 Aug 19

PMID 39160415

Authors

Sergio Cedillo

Almudena Gonzalez-Dominguez

Yoana Ivanova-Markova

Rafael Lopez Lopez

Sara Lopez-Tarruella Cobo

Jose Alberto Pena Pedrosa

Affiliations

Soon will be listed here.

Abstract

Objective: Here we estimate the cost-effectiveness of olaparib in the Spanish National Health Service (SNHS) as adjuvant treatment of early germline mutations in the BRCA1/2 genes (gBRCAm) HER2-negative (HER2neg) breast cancer (BC) with high risk of recurrence.

Methods: A semi-Markov model was adapted to the Spanish healthcare setting, using the perspective of the SNHS, and a lifetime horizon. Two scenarios were compared: receiving olaparib versus standard of care (SoC) treatment. The model comprised five health states and included the clinical results of the OlympiA trial, along with the direct healthcare costs associated with the use of early BC and subsequent treatment resources (€2023). A discount rate of 3% was applied for future cost and quality-of-life outcomes. A probabilistic sensitivity analysis (PSA) was carried out.

Results: The introduction of olaparib as adjuvant treatment for patients with early gBRCAm HER2neg BC with high risk of recurrence could involve an incremental cost of €44,273 and €50,164, with an improvement of 1.14 and 1.28 quality-adjusted life years (QALYs) for hormone receptor-positive (HR) and triple-negative (TN) patients, respectively. Therefore, adjuvant olaparib could be cost-effective for early gBRCAm HER2neg BC, with an incremental cost-effectiveness ratio of €38,839/QALY and €39,084/QALY for HR and TN patients, respectively. The results from the PSA showed that 75.7% and 82.2% of the simulations fell below the €60,000/QALY threshold.

Conclusions: Olaparib as adjuvant treatment could be cost-effective in gBRCAm patients with early HER2neg BC in Spain.

References

Longworth L, Yang Y, Young T, Mulhern B, Alava M, Mukuria C . Use of generic and condition-specific measures of health-related quality of life in NICE decision-making: a systematic review, statistical modelling and survey. Health Technol Assess. 2014; 18(9):1-224. PMC: 4780954. DOI: 10.3310/hta18090. View

Rebbeck T, Mitra N, Wan F, Healey S, McGuffog L, Chenevix-Trench G . Association of type and location of BRCA1 and BRCA2 mutations with risk of breast and ovarian cancer. JAMA. 2015; 313(13):1347-61. PMC: 4537700. DOI: 10.1001/jama.2014.5985. View

Mai P, Chatterjee N, Hartge P, Tucker M, Brody L, Struewing J . Potential excess mortality in BRCA1/2 mutation carriers beyond breast, ovarian, prostate, and pancreatic cancers, and melanoma. PLoS One. 2009; 4(3):e4812. PMC: 2652075. DOI: 10.1371/journal.pone.0004812. View

Davie A, Traore S, Giovannitti M, Pompilio G, Lambton M, Cakar E . Cost-effectiveness analysis of abemaciclib with endocrine therapy (ET) versus ET alone for HR+, HER2-, node-positive, high-risk early breast cancer in Italy. Glob Reg Health Technol Assess. 2023; 10:62-69. PMC: 10551672. DOI: 10.33393/grhta.2023.2561. View

Richman J, Dowsett M . Beyond 5 years: enduring risk of recurrence in oestrogen receptor-positive breast cancer. Nat Rev Clin Oncol. 2018; 16(5):296-311. DOI: 10.1038/s41571-018-0145-5. View

tKint de Roodenbeke M, Ponde N, Buisseret L, Piccart M . Management of early breast cancer in patients bearing germline BRCA mutations. Semin Oncol. 2020; 47(5):243-248. DOI: 10.1053/j.seminoncol.2020.07.006. View

Sacristan J, Oliva J, Campillo-Artero C, Puig-Junoy J, Pinto-Prades J, Dilla T . [What is an efficient health intervention in Spain in 2020?]. Gac Sanit. 2019; 34(2):189-193. DOI: 10.1016/j.gaceta.2019.06.007. View

Ayala de la Pena F, Antolin Novoa S, Gavila Gregori J, Gonzalez Cortijo L, Henao Carrasco F, Martinez Martinez M . SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol. 2023; 25(9):2647-2664. PMC: 10425528. DOI: 10.1007/s12094-023-03215-4. View

Iino H, Hashiguchi M, Hori S . Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review. PLoS One. 2022; 17(4):e0266934. PMC: 9009631. DOI: 10.1371/journal.pone.0266934. View

10.

Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J . Health state utilities for metastatic breast cancer. Br J Cancer. 2006; 95(6):683-90. PMC: 2360509. DOI: 10.1038/sj.bjc.6603326. View

11.

Orozco Leal G, Armstrong N, Kernohan A, Ahmadu C, Coughlan D, McDermott K . Abemaciclib in Combination with Endocrine Therapy for Adjuvant Treatment of Hormone Receptor-Positive, HER2-Negative, Node-Positive Early Breast Cancer: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. 2023; 41(7):741-750. PMC: 10034868. DOI: 10.1007/s40273-023-01259-6. View

12.

Polyzoi M, Ekman M, Reithmeier A, Jacob J, Karlsson E, Bertranou E . Cost-Effectiveness Analysis of Adjuvant Olaparib Versus Watch and Wait in the Treatment of Germline BRCA1/2-Mutated, High-Risk, HER2-Negative Early Breast Cancer in Sweden. Pharmacoecon Open. 2023; 8(2):277-289. PMC: 10884392. DOI: 10.1007/s41669-023-00457-4. View

13.

Arrospide A, Soto-Gordoa M, Acaiturri T, Lopez-Vivanco G, Abecia L, Mar J . [Cost of breast cancer treatment by clinical stage in the Basque Country, Spain]. Rev Esp Salud Publica. 2015; 89(1):93-7. DOI: 10.4321/S1135-57272015000100010. View

14.

Zettler C, De Silva D, Blinder V, Robson M, Elkin E . Cost-Effectiveness of Adjuvant Olaparib for Patients With Breast Cancer and Germline BRCA1/2 Mutations. JAMA Netw Open. 2024; 7(1):e2350067. PMC: 10765260. DOI: 10.1001/jamanetworkopen.2023.50067. View

15.

Sopik V, Sun P, Narod S . Predictors of time to death after distant recurrence in breast cancer patients. Breast Cancer Res Treat. 2018; 173(2):465-474. DOI: 10.1007/s10549-018-5002-9. View

16.

Cortesi L, Rugo H, Jackisch C . An Overview of PARP Inhibitors for the Treatment of Breast Cancer. Target Oncol. 2021; 16(3):255-282. PMC: 8105250. DOI: 10.1007/s11523-021-00796-4. View

17.

Tilanus-Linthorst M, Lingsma H, Evans D, Thompson D, Kaas R, Manders P . Optimal age to start preventive measures in women with BRCA1/2 mutations or high familial breast cancer risk. Int J Cancer. 2013; 133(1):156-63. DOI: 10.1002/ijc.28014. View

18.

Fu X, Tan W, Song Q, Pei H, Li J . BRCA1 and Breast Cancer: Molecular Mechanisms and Therapeutic Strategies. Front Cell Dev Biol. 2022; 10:813457. PMC: 8921524. DOI: 10.3389/fcell.2022.813457. View

19.

Baretta Z, Mocellin S, Goldin E, Olopade O, Huo D . Effect of BRCA germline mutations on breast cancer prognosis: A systematic review and meta-analysis. Medicine (Baltimore). 2016; 95(40):e4975. PMC: 5059054. DOI: 10.1097/MD.0000000000004975. View

20.

Robson M, Ruddy K, Im S, Senkus E, Xu B, Domchek S . Patient-reported outcomes in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer receiving olaparib versus chemotherapy in the OlympiAD trial. Eur J Cancer. 2019; 120:20-30. PMC: 6836724. DOI: 10.1016/j.ejca.2019.06.023. View