ABSTRACT
OBJECTIVE: To assess the economic burden of epithelial ovarian cancer (EOC) in incident patients and the burden by disease stage in Spain. METHODS: We developed a Markov model from a social perspective simulating the natural history of EOC and its four stages, with a 10-year time horizon, 3-week cycles, 3% discount rate, and 2016 euros. Healthcare resource utilization and costs were estimated by disease stage. Direct healthcare costs (DHC) included early screening, genetic counselling, medical visits, diagnostic tests, surgery, chemotherapy, hospitalizations, emergency services, and palliative care. Direct non-healthcare costs (DNHC) included formal and informal care. Indirect costs (IC) included labour productivity losses due to temporary and permanent leaves, and premature death. Epidemiology data and resource use were taken from the literature and validated for Spain by the OvarCost group using a Delphi method. RESULTS: The total burden of EOC over 10 years was 3102 mill euros: 15.1% in stage I, 3.9% in stage II, 41.0% in stage III, and 40.2% in stage IV. Annual average cost/patient was 24,111 and it was 8,641; 14,184; 33,858, and 42,547 in stages I-IV, respectively. Of total costs, 71.2% were due to DHC, 24.7% to DNHC, and 4.1% to IC. CONCLUSIONS: EOC imposes a significant economic burden on the national healthcare system and society in Spain. Investment in better early diagnosis techniques might increase survival and patients' quality of life. This would likely reduce costs derived from late stages, consequently leading to a substantial reduction of the economic burden associated with EOC.
Subject(s)
Carcinoma, Ovarian Epithelial/economics , Cost of Illness , Health Care Costs/statistics & numerical data , Ovarian Neoplasms/economics , Aged , Carcinoma, Ovarian Epithelial/diagnosis , Carcinoma, Ovarian Epithelial/therapy , Early Detection of Cancer/economics , Female , Humans , Markov Chains , Middle Aged , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/therapy , Patient Acceptance of Health Care/statistics & numerical data , SpainABSTRACT
Objective: 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. Method: 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 (Euros 2017) were considered: pharmacological, administration, adverse effects and genetic tests. The robustness of the model was verified by a univariate sensitivity analysis. Results: 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 Euros 1.6 and Euros 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. Conclusions: 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
Objetivo: Estimar el impacto económico de la introducción de olaparib en el Sistema Nacional de Salud como monoterapia de mantenimiento en pacientes con cáncer de ovario seroso de alto grado y mutación BRCA. Método: Se desarrolló un modelo de impacto presupuestario desde la perspectiva del Sistema Nacional de Salud y un horizonte temporal de cinco años a lo largo de cuatro líneas de tratamiento. El modelo incluye pacientes prevalentes e incidentes estimadas a partir de datos epidemiológicos españoles. Las pacientes se mueven entre las líneas de tratamiento en función de las curvas de supervivencia libre de progresión y supervivencia global obtenidas de los respectivos ensayos clínicos. Solo se consideraron costes directos (Euros 2017): farmacológicos, de administración, efectos adversos y test genéticos. La robustez del modelo se ha comprobado a través de un análisis de sensibilidad univariante. Resultados: El uso de olaparib conllevó que, tras cinco años, un 6% menos de pacientes progresaran a líneas posteriores, en comparación al escenario sin olaparib, permaneciendo más tiempo en segunda línea y retrasando el inicio de líneas subsiguientes. El impacto presupuestario total estimado osciló entre 1,6 y 5,4 millones de euros (1-5 años). Este impacto económico se ve parcialmente compensado por los costes de la quimioterapia, el manejo de sus efectos adversos y los cuidados paliativos, los cuales producen ahorros para el Sistema Nacional de Salud. Conclusiones: Olaparib como tratamiento de mantenimiento en pacientes con cáncer de ovario seroso de alto grado y mutación del gen BRCA aumenta la supervivencia libre de progresión y retrasa la utilización de quimioterapia posteriores, con un impacto presupuestario para el Sistema Nacional de Salud de 5,4 millones de euros tras 5 años
Subject(s)
Humans , Female , Antineoplastic Agents/economics , Ovarian Neoplasms/drug therapy , Genes, BRCA1 , Genes, BRCA2 , Antineoplastic Agents/therapeutic use , Genes, Tumor Suppressor , Poly Adenosine Diphosphate Ribose , Poly(ADP-ribose) Polymerase InhibitorsABSTRACT
OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
Objetivo: Estimar el impacto económico de la introducción de olaparib en el Sistema Nacional de Salud como monoterapia de mantenimiento en pacientes con cáncer de ovario seroso de alto grado y mutación BRCA.Método: Se desarrolló un modelo de impacto presupuestario desde la perspectiva del Sistema Nacional de Salud y un horizonte temporal de cinco años a lo largo de cuatro líneas de tratamiento. El modelo incluye pacientes prevalentes e incidentes estimadas a partir de datos epidemiológicos españoles. Las pacientes se mueven entre las líneas de tratamiento en función de las curvas de supervivencia libre de progresión y supervivencia global obtenidas de los respectivos ensayos clínicos. Solo se consideraron costes directos ( 2017): farmacológicos, de administración, efectos adversos y test genéticos. La robustez del modelo se ha comprobado a través de un análisis de sensibilidad univariante.Resultados: El uso de olaparib conllevó que, tras cinco años, un 6% menos de pacientes progresaran a líneas posteriores, en comparación al escenario sin olaparib, permaneciendo más tiempo en segunda línea y retrasando el inicio de líneas subsiguientes. El impacto presupuestario total estimado osciló entre 1,6 y 5,4 millones de euros (1-5 años). Este impacto económico se ve parcialmente compensado por los costes de la quimioterapia, el manejo de sus efectos adversos y los cuidados paliativos, los cuales producen ahorros para el Sistema Nacional de Salud.Conclusiones: Olaparib como tratamiento de mantenimiento en pacientes con cáncer de ovario seroso de alto grado y mutación del gen BRCA aumenta la supervivencia libre de progresión y retrasa la utilización de quimioterapia posteriores, con un impacto presupuestario para el Sistema Nacional de Salud de 5,4 millones de euros tras 5 año.