Abstract
Background
Maintenance therapy with poly (ADP-ribose) polymerase inhibitors (PARPis) plays a crucial role in managing primary epithelial ovarian cancer (OC), especially in patients with a BRCA mutation. However, there is a lack of economic evaluation comparing various PARPis.
Aim
This study aimed to investigate the cost-effectiveness of fuzuloparib compared to routine surveillance, olaparib, niraparib, and olaparib plus bevacizumab for maintenance therapy of patients with a BRCA mutation and primary epithelial OC in China.
Method
A cost-effectiveness model was constructed in Microsoft Excel®, predominantly based on the data derived from FZOCUS-1, SOLO-1, PRIME, and PAOLA-1 trials. The proportion of disease-free patients alongside the 24-month model horizon was estimated by parameterizing the reconstructed patient-level data, which was digitized from the publicly available Kaplan-Meier progression-free survival (PFS) estimators. Unit costs for both health resource utilization and adverse event (AE) management were systematically sourced from peer-reviewed literature and authoritative official websites. An annual discount rate of 5% was used for both costs and PFS-life years (PFS-LY). Sensitivity analyses (SA) were performed to explore the parameter uncertainties.
Results
The base-case incremental cost-effectiveness ratios (ICER) were ¥1,130,845/PFS-LY, ¥602,152/PFS-LY, ¥855,688/PFS-LY, and ¥1,176,300/PFS-LY for fuzuloparib, olaparib, niraparib, and olaparib plus bevacizumab respectively. Probabilistic sensitivity analysis (PSA) confirms the robustness of these findings to parameter uncertainty.
Conclusion
From the perspective of the Chinese healthcare system, olaparib emerges as the most cost-effective option for maintenance therapy of patients with a BRCA mutation and primary epithelial OC, followed by niraparib, then fuzuloparib, while olaparib plus bevacizumab ranks as the least cost-effective.