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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.
Cancers
|January 11, 2025
Summary
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.
