Recommendations for CEAs of PARP inhibitors for ovarian cancer
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Recommendations for CEAs of PARP inhibitors for ovarian cancer Following a systematic review which found uncertainties in published cost-effectiveness analyses (CEAs) on poly(ADP-ribose) polymerase (PARP) inhibitors, recommendations to improve the consistency and qualities of analyses assessing the cost effectiveness of PARP inhibitors in the treatment of advanced ovarian cancer have been reported in a study published in PharmacoEconomics. Investigators searched MEDLINE and EMBASE databases up to June 2019, and 2016–2019 annual meetings of the American Society of Clinical Oncology, Society of Gynecologic Oncology, International Society for Pharmacoeconomics and Outcomes Research, and the European Society for Medical Oncology, for CEAs on PARP inhibitor treatment in patients with advanced ovarian cancer. Most of the 18 CEAs which met the inclusion criteria evaluated the cost effectiveness of PARP inhibitors from a US healthcare or societal perspective. The most frequently reported outcomes reported were surrogate outcomes; 14 CEAs reported incremental costs per progression-free life-year (PF LY) gained, or per PF QALY gained, while only five reported incremental costs per LY or QALY gained. The incremental cost per PF LY gained ranged from €63 046 to $600 000 [US dollars] for olaparib versus placebo, from $248 992 to $496 157 for rucaparib versus placebo, and from $197 000 to $304 775 for niraparib versus placebo. The primary drivers of cost effectiveness were costs, treatment duration, treatment effects, health utility, and the prevalence of BRCA gene mutations. Sensitivity or scenario analyses were included in all five full-text studies, but four of these studies were based on progression-free survival (PFS) data and had time horizons of less than two years. The conclusions of most studies were based on surrogate outcomes, despite the lack of a theoretical or empirical willingness-to-pay threshold. "Recommendations specific to PARP inhibitor evaluations are related to outcomes, model validation, uncertainty, and conclusions on value. Generic outcomes (QALYs) and cancer-specific outcomes (PF LYs) should both be included to increase comparability across past and future studies," said the authors. Given the lack of mature overall survival (OS) data, we recommend "multiple uncertainty analyses that link different assumptions between PFS and OS; and/or estimate clinical benchmarks on OS that would meet commonly cited cost-effectiveness thresholds," they added. Gao W, et al. A Critical Appraisal and Recommendations for Cost-Effectiveness Studies of Poly(ADP-Ribose) Polymerase Inhibitors in Advanced Ovarian Cancer. PharmacoEconomics : 14 Aug 2020. Available from: URL: https://doi.org/10.1007/s40273-020-00949-9
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PharmacoEconomics & Outcomes News 22 Aug 2020 No. 860
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