Cost-Utility Analysis of Adjuvant Olaparib for Germline BRCA1/2-Mutated, High-Risk HER2-Negative Early Breast Cancer
Sergio Cedillo1, Almudena González-Domínguez2, Yoana Ivanova-Markova3
1AstraZeneca Farmacéutica Spain S.A., Puerto de Somport 21-23, 28050, Madrid, Spain.
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.
Insights
Olaparib is a cost-effective adjuvant treatment for early HER2-negative breast cancer (BC) with BRCA1/2 gene mutations in Spain. This targeted therapy improves quality-adjusted life years (QALYs) for both hormone receptor-positive and triple-negative patients.
Area of Science:
- Oncology
- Health Economics
- Pharmacoeconomics
Background:
- Adjuvant olaparib is considered for early HER2-negative breast cancer (BC) with germline BRCA mutations (gBRCAm) and high recurrence risk.
- The cost-effectiveness of olaparib within the Spanish National Health Service (SNHS) requires evaluation for this patient population.
Purpose of the Study:
- To estimate the cost-effectiveness of olaparib versus standard of care (SoC) as adjuvant treatment for early gBRCAm HER2-negative BC in the SNHS.
- To assess the economic value of olaparib for high-risk early-stage breast cancer patients with specific genetic mutations.
Main Methods:
- A semi-Markov model was adapted for the Spanish healthcare setting with a lifetime horizon.
- Clinical data from the OlympiA trial and direct healthcare costs were incorporated.
- Probabilistic sensitivity analysis (PSA) was performed to evaluate cost-effectiveness.
Main Results:
- Olaparib demonstrated an incremental cost of €44,273-€50,164, with an improvement of 1.14-1.28 quality-adjusted life years (QALYs) for HR+ and TN patients, respectively.
- The incremental cost-effectiveness ratio (ICER) for olaparib was €38,839/QALY (HR+) and €39,084/QALY (TN).
- PSA indicated that 75.7% (HR+) and 82.2% (TN) of simulations were below the €60,000/QALY threshold.
Conclusions:
- Adjuvant olaparib is likely cost-effective for treating early gBRCAm HER2-negative BC in Spain.
- The findings support the use of olaparib in this specific patient subgroup within the SNHS.
