How Cost-Effective Is Adjuvant Therapy With Olaparib in Breast Cancer?

By: Joshua D. Madera, MD
Posted: Friday, March 1, 2024

Despite the clinical benefits of the PARP inhibitor olaparib, the agent’s price tag has raised the question of its cost-effectiveness for patients with high-risk, early-stage breast cancer, according to a study published in JAMA Network Open. The study findings suggest that based on the calculated incremental cost-effectiveness ratio for adjuvant olaparib, the drug represents a cost-effective value at its 2021 price, explained Elena B. Elkin, PhD, MPA, of Columbia University Mailman School of Public Health, New York, and colleagues.

Using a Markov-state transition model, an economic evaluation was performed from 2021 to 2023. This model used simulations of 42-year-old women with high-risk, early-stage breast cancer and a BRCA1/2 mutation who received previous therapeutic interventions to estimate the costs and lifetime health outcomes. Patients were stratified based on whether they received adjuvant olaparib therapy. Olaparib efficacy was based on the OlympiA clinical trial, and the same disease-free and overall survival monitoring schedule was followed for the first 4 years.

The study authors reported an improved life expectancy (1.3 years) and quality-adjusted life-years (1.2 years) in patients who received treatment with olaparib. The estimated incremental cost in patients treated with olaparib was $133,333 compared with that of patients who did not receive olaparib therapy. In addition, the incremental cost-effectiveness ratio was estimated at approximately $111,000 per quality-adjusted life-year. Furthermore, olaparib was deemed cost-effective based on its price in 2021, as determined by a willingness-to-pay threshold of $150,000 per quality-adjusted life-year. These findings held true across more than 92% of probabilistic sensitivity analysis simulations and remained sensitive based on assumptions regarding the efficacy of olaparib.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

JAMA Network Open

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