Presentation (CTI)

OBJECTIVES: This study aimed to evaluate the cost-effectiveness, from Taiwan public payer perspective, of olaparib with abiraterone and prednisolone (OLA+AAP) and niraparib with abiraterone and prednisolone (NIRA+AAP) versus abiraterone with prednisolone (AAP) alone for first-line treatments of BRCA-mutated metastatic castration-resistant prostate cancer (mCRPC).
METHODS: Treatment and control arms were constructed by different model types to better align with the reimbursement situation in Taiwan. A 30-year partitioned survival model for the treatment arm and a combined partitioned survival/state transition model for the control arm were used. Models then divided memberships into three and four states, respectively. Efficacy inputs were derived from network meta-analysis of clinical trials, which were PROpel (1st line OLA+AAP vs AAP) and MAGNITUDE (1st line NIRA+AAP vs AAP) trial. PROfound trial (second-line OLA vs abiraterone/enzalutamide) was then incorporated in the control arm through state transition model. Cost inputs were collected from the National Health Insurance Research Database, Taiwan. Utility inputs were from literature. We analyzed the incremental cost-effectiveness ratio, deterministic and probabilistic sensitivity.
RESULTS: The mean costs were 151,365 USD (1 USD= 32.92 TWD) with 1st line AAP alone and 184,635 USD, 488,214 USD with NIRA+AAP, OLA+AAP. The mean QALYswere 3.27 with AAP alone and 3.24, 5.24 with NIRA+AAP, OLA+AAP. When compared to AAP alone, OLA+AAP hadan ICER of 170,812 USD/QALY. NIRA+AAP was dominated by 1^st-line AAP following 2^nd-line OLA. At a willingness topay(WTP) threshold below 165,000 USD/QALY, 1^st-lineAAP with 2^nd-line OLA is likely the most cost-effective treatment. At a WTP threshold above 165,000 USD/QALY, 1^st-lineOLA+AAP is likely the most cost-effective treatment.
CONCLUSIONS: Findings suggest that AAP is likely to be a cost-effective first-line treatment option for BRCA-mutated mCRPC from Taiwanperspective.