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Abstract
Introduction Niraparib maintenance treatment using individualized starting dosage (ISD) demonstrated improved survival outcomes for Chinese platinum-sensitive recurrent ovarian cancer (PSROC) patients versus routine surveillance in NORA trial. We elevated the cost-effectiveness of maintenance niraparib ISD vs routine surveillance in Chinese PSROC patients.
Methods Clinical data from NORA trial was simulated using Markov model for costs and health outcomes. Quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) were measured. One-way and probabilistic sensitivity analysis were performed to estimate the model robustness. Scenario analyses were also conducted. Study period was from June 2022 to January 2023.
Results Niraparib ISD increased QALYs by 0.59 and 0.30 in PSROC patients with and without germline BRCA (gBRCA) mutations, respectively vs routine surveillance; incremental costs were $10,860.79 and $12,098.54, respectively. The ICERs of niraparib ISD over routine surveillance were $18,653.67/QALY and $39,212.99/QALY, respectively. At the willingness-to-pay (WTP) threshold of $37,488/QALY, niraparib ISD enhanced the likelihood of cost-effectiveness from 9.35% to 30.73% in the gBRCA-mutated and from 0.77% to 11.74% in the non-gBRCA mutated patients. In China’s highest per capita GDP region, 74.23% of gBRCA-mutated and 76.10% of non-gBRCA-mutated population considered niraparib to be cost-effective. The probability of maintaining niraparib being cost-effective for those covered by the National Basic Medical Insurance program was 100%.
Conclusion/Implications Maintenance niraparib ISD is cost-effective in gBRCA-mutated PSROC patients vs routine surveillance in China. It is found to be expensive and more effective in non-gBRCA-mutated patients. The optimized niraparib price, economic status, and health insurance coverage may benefit the economic outcome.
Tornado diagrams of one-way sensitivity analyses with greatest influence variables. Association of variables with the ICER of niraparib versus routine surveillance for platinum-sensitive recurrent ovarian cancer (A) the gBRCAm cohort (B) the non-gBRCAm cohort. PD, progressed disease
Cost-effectiveness acceptability curves generated from the probabilistic sensitivity analysis (10,000 iterations) for the niraparib and routine surveillance groups (A) gBRCAm cohort and (B) Non-gBRCAm cohort