Cost-effectiveness of PARP inhibitors in malignancies: A systematic review

Haiying Ding; Chaoneng He; Yinghui Tong; Qilu Fang; Xiufang Mi; Lingya Chen; Wenxiu Xin; Luo Fang

doi:10.1371/journal.pone.0279286

Cost-effectiveness of PARP inhibitors in malignancies: A systematic review

PLoS One. 2022 Dec 15;17(12):e0279286. doi: 10.1371/journal.pone.0279286. eCollection 2022.

Authors

Haiying Ding¹, Chaoneng He¹, Yinghui Tong¹, Qilu Fang¹, Xiufang Mi¹, Lingya Chen¹, Wenxiu Xin¹, Luo Fang¹

Affiliation

¹ Department of Pharmacy, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.

Abstract

Objectives: Poly (ADP-ribose) polymerase inhibitor (PARPi) have become a mainstay for the treatment of BRCA-mutant malignancies. PARPis are likely to be more effective but also bring an increase in costs. Thus, we aimed at evaluating the cost effectiveness of PARPis in the treatment of malignancies.

Methods: Studies of cost effectiveness of PARPis were searched from PubMed, Web of Science, and Cochrane Library. Key information was extracted from the identified studies and reviewed. Quality of the included studies was evaluated using Quality of Health Economic Studies (QHES) instrument. Modeling techniques, measurement of parameters and uncertainty analysis were analyzed across studies. Interventions and cost-effectiveness results were reported stratified by patient population.

Results: Among the 25 studies identified, we included 17 on ovarian cancer, 2 on breast cancer, 3 on pancreatic cancer, and 3 on prostate cancer that involved olaparib, niraparib, rucaparib, and talazoparib. All studies had a QHES score of above 75. In the maintenance therapy of ovarian cancer, additional administration of olaparib was cost-effective for newly diagnosed patients after first-line platinum-based chemotherapy but was not cost-effective for platinum-sensitive recurrent patients in majority studies. However, the economic value of other PARPis in ovarian cancer as well as all PARPis in other tumors remained controversial. Cost-effectiveness of PARPi was primarily impacted by the costs of PARPi, survival time, health utility and discount rate. Moreover, genetic testing improved the cost-effectiveness of PARPi treatment.

Conclusions: PARPi is potentially cost-effective for patients with ovarian, pancreatic, or prostate cancer. Genetic testing can improve the cost-effectiveness of PARPi.

Copyright: © 2022 Ding et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Agents* / therapeutic use
Cost-Benefit Analysis
Female
Humans
Male
Ovarian Neoplasms* / diagnosis
Ovarian Neoplasms* / drug therapy
Ovarian Neoplasms* / genetics
Poly(ADP-ribose) Polymerase Inhibitors / pharmacology
Prostatic Neoplasms* / drug therapy

Substances

Poly(ADP-ribose) Polymerase Inhibitors
Antineoplastic Agents

Grants and funding

This work was supported by Natural Science Foundation of Zhejiang Province (LQ19H280001); Projects of Medical and Health Technology Program in Zhejiang Province (2019KY037; 2022KY090); Project of Clinical Comprehensive Pharmaceutical Evaluation of Zhejiang Pharmaceutical Association (2022ZYYL20); Special Research Program of Pharmacoeconomics and Health Technology Assessment Committee of Zhejiang Pharmaceutical Association (2022ZYJ10; 2022ZYJ18). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.