Economic impact of olaparib on maintenance treatment of patients with BRCA-mutation positive, platinum-sensitive relapsing high-grade serous epithelial ovarian cancer in Spain

Laura Delgado-Ortega, Jordi Ginés Rubió, Maria Del Carmen Garcías de España, David Carcedo, Luis Cordero Puentes, Carlota Moya de Alarcón

To estimate the economic impact of the introduction of olaparib in  the Spanish National Health System as maintenance monotherapy in patients  with BRCA-mutation positive high-grade serous ovarian cancer. A budget impact model was developed from the Spanish NHS perspective and a time horizon of 5 years for four treatment lines. The model included prevalent and incident patients estimated according to Spanish epidemiological data. Patients moved between treatment lines according to the progression-free survival and overall survival curves  obtained from the respective clinical trials. Only direct costs (€ 2017) were considered: pharmacological, administration, adverse effects and genetic tests. The robustness of the model was verified by a univariate  sensitivity analysis. The use of olaparib meant that, after 5 years, 6% fewer patients progressed to later lines compared to scenario without olaparib,  remaining longer in the second line and delaying the initiation of subsequent lines. The total estimated budgetary impact ranged between € 1.6  and € 5.4 million (1-5 years). The economic impact associated to the  introduction of olaparib is partially offset by the lower cost of chemotherapy, related adverse events, and palliative care in patients with  olaparib than in patients without it. Olaparib as maintenance treatment in patients with BRCA-mutation positive high-grade serous ovarian cancer increases progression-free  survival and delays the use of subsequent chemotherapy, with an budgetary  impact for the Spanish National Health System of 5.4 million euros after 5 years.