Related Experiment Video
Updated: Jun 3, 2025
A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Cost-Effectiveness of PARP Inhibitors for Patients with BRCA1/2-Positive Metastatic Castration-Resistant Prostate
Ivan Yanev1,2, Armen G Aprikian3, Brendan L Raizenne4
1Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
Background/Objectives:
Through phase III clinical trials, PARP inhibitors have demonstrated outcome improvements in mCRPC patients with alterations in BRCA1/2 genes who have progressed on a second-generation androgen receptor pathway inhibitor (ARPI). While improving outcomes, PARP inhibitors contribute to the ever-growing economic burden of PCa. The objective of this project is to evaluate the cost-effectiveness of PARP inhibitors (olaparib, rucaparib, or talazoparib) versus the SOC (docetaxel or androgen receptor pathway inhibitors (ARPI)) for previously progressed mCRPC patients with BRCA1/2 mutations from the Canadian healthcare system perspective.
Methods:
Partitioned survival models were created to represent mCRPC disease after progression until death. Survival inputs for BRCA1/2-mutated patients were extracted from the PROfound, TRITON3, and TALAPRO-1 clinical trials, while Canadian-specific costs are presented in 2023 dollars. Upon progression, patients were treated with chemotherapy. The considered time horizon was 5 years and outcomes were discounted at 1.5% per year.
Results:
PARP inhibitors provide an additional survival of 0.19 quality-adjusted life years (QALY) when compared to the current standard of care, with additional costs of CAD 101,679 resulting in an incremental cost-utility ratio (ICUR) of CAD 565,383/QALY. The results were most sensitive to PARP inhibitors' acquisition costs and health-state utilities. PARP inhibitors required price reductions of up to 83% to meet the CAD 50,000/QALY willingness-to-pay threshold (WTP).
Conclusions:
While providing survival benefits to previously progressed mCRPC patients presenting deleterious BRCA1/2 gene mutations, PARP inhibitors are not cost-effective and require major price reductions to reach local WTP thresholds.
Insights
PARP inhibitors offer survival benefits for BRCA1/2-mutated metastatic castration-resistant prostate cancer (mCRPC) patients but are not cost-effective. Significant price reductions are needed for these treatments to meet Canadian willingness-to-pay thresholds.
Area of Science:
- Oncology
- Health Economics
- Pharmacoeconomics
Background:
- PARP inhibitors improve outcomes in BRCA1/2-mutated mCRPC patients post-androgen receptor pathway inhibitor (ARPI) therapy.
- These advancements add to the economic burden of prostate cancer (PCa).
Purpose of the Study:
- To evaluate the cost-effectiveness of PARP inhibitors (olaparib, rucaparib, talazoparib) versus standard of care (docetaxel or ARPIs) for previously treated mCRPC patients with BRCA1/2 mutations.
- Analysis conducted from the Canadian healthcare system perspective.
Main Methods:
- Partitioned survival models were used to simulate mCRPC progression post-treatment.
- Data from PROfound, TRITON3, and TALAPRO-1 trials informed survival inputs for BRCA1/2-mutated patients.
- Canadian costs were applied (2023 dollars) over a 5-year horizon with a 1.5% discount rate.
Main Results:
- PARP inhibitors yielded an additional 0.19 quality-adjusted life years (QALYs) at an extra cost of CAD 101,679.
- The incremental cost-utility ratio (ICUR) was CAD 565,383/QALY.
- Results were sensitive to acquisition costs and health-state utilities; price reductions up to 83% are needed to reach the CAD 50,000/QALY willingness-to-pay (WTP) threshold.
Conclusions:
- PARP inhibitors provide survival benefits for mCRPC patients with BRCA1/2 mutations.
- However, they are not cost-effective at current prices.
- Substantial price reductions are necessary to align with Canadian WTP thresholds.
