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Published on: March 6, 2018
The cost-effectiveness of germline BRCA testing-guided olaparib treatment in metastatic castration resistant prostate
Srinivas Teppala1, Paul A Scuffham1,2, Haitham Tuffaha3
1Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.
Background:
Olaparib targets the DNA repair pathways and has revolutionized the management of metastatic castration resistant prostate cancer (mCRPC). Treatment with the drug should be guided by genetic testing; however, published economic evaluations did not consider olaparib and genetic testing as codependent technologies. This study aims to assess the cost-effectiveness of BRCA germline testing to inform olaparib treatment in mCRPC.
Methods:
We conducted a cost-utility analysis of germline BRCA testing-guided olaparib treatment compared to standard care without testing from an Australian health payer perspective. The analysis applied a decision tree to indicate the germline testing or no testing strategy. A Markov multi-state transition approach was used for patients within each strategy. The model had a time horizon of 5 years. Costs and outcomes were discounted at an annual rate of 5 percent. Decision uncertainty was characterized using probabilistic and scenario analyses.
Results:
Compared to standard care, BRCA testing-guided olaparib treatment was associated with an incremental cost of AU$7,841 and a gain of 0.06 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY. The probability of BRCA testing-guided treatment being cost effective at a willingness-to-pay threshold of AU$100,000 per QALY was around 2 percent; however, the likelihood for cost-effectiveness increased to 66 percent if the price of olaparib was reduced by 30 percent.
Conclusion:
This is the first study to evaluate germline genetic testing and olaparib treatment as codependent technologies in mCRPC. Genetic testing-guided olaparib treatment may be cost-effective with significant discounts on olaparib pricing.
Insights
BRCA germline testing guides olaparib treatment for metastatic castration resistant prostate cancer (mCRPC). This approach may be cost-effective if olaparib prices are reduced.
Area of Science:
- Oncology
- Health Economics
- Genetics
Background:
- Olaparib has transformed metastatic castration resistant prostate cancer (mCRPC) management by targeting DNA repair pathways.
- Current economic evaluations often overlook the interdependence of olaparib treatment and genetic testing.
- This study investigates the cost-effectiveness of germline BRCA testing to guide olaparib therapy in mCRPC.
Purpose of the Study:
- To assess the cost-effectiveness of germline BRCA testing to guide olaparib treatment in mCRPC.
- To compare a strategy of BRCA testing-guided olaparib treatment versus standard care without genetic testing.
- To evaluate the economic implications from an Australian health payer perspective.
Main Methods:
- A cost-utility analysis was performed using a decision tree and a Markov multi-state model.
- The model simulated patient pathways over a 5-year time horizon.
- Probabilistic and scenario analyses were used to characterize decision uncertainty.
Main Results:
- BRCA testing-guided olaparib treatment incurred an incremental cost of AU$7,841, yielding 0.06 quality-adjusted life-years (QALYs).
- The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY.
- Cost-effectiveness probability increased to 66% with a 30% reduction in olaparib price.
Conclusions:
- This study is the first to examine germline genetic testing and olaparib as codependent technologies for mCRPC.
- BRCA testing-guided olaparib treatment shows potential cost-effectiveness, particularly with substantial olaparib price reductions.
- The findings suggest that strategic pricing could enhance the value of genetic testing-guided precision medicine in mCRPC.
