Ovarian cancer patients who respond to chemo have some new treatments designed to keep their disease at bay. But a cost-effectiveness watchdog isn’t convinced those meds are worth their price in that setting, and only one hit a cost target in recurrent disease.
Those drugs are PARP inhibitors, led by AstraZeneca’s first-to-market Lynparza, and the entire class has, in separate clinical trials, held off a recurrence longer than placebo for a median of at least one year. The Institute for Clinical and Economic Research figures that the meds deliver clinical benefits, particularly in women whose cancers have a BRCA mutation.
That doesn’t mean the price tags fit that benefit, though, ICER says in its final report on the subject. After running a preliminary report through public comment, and running data through its own economic model, the group said all PARP meds would need discounts of at least 50% to be cost-effective in preventing a recurrence.
The drugs carry monthly list prices of $13,679 to $14,965—and their estimated net prices that are all north of $12,000, the group says.
Tesaro’s Zejula (niraparib), the first PARP inhibitor approved for maintenance treatment, is at the high end of that range, and it would need a price cut of at least 57% to come in under a $150,000 cost of a quality-adjusted life year (QALY), a common measure of cost-effectiveness.
Lynparza, which won the indication in August, would need to cost 59% less, according to ICER. Rubraca, which Clovis Oncology hopes to expand into maintenance therapy next year, would need to be cut back by 65% to come in under that level.
What does this mean in dollar terms? For Rubraca, the monthly list price of $13,940 would need to come down to $4,817. Lynparza’s list of $13,679 would need to drop to $5,607, and Zejula’s $14,965 price tag would need to come down to $6,437.
In responses to the watchdog's earlier report, the drugmakers expressed concerns that such conclusions by ICER might be used to restrict patient access to an innovative class of therapies. A Clovis spokesperson said at the time the ICER report "does not fully account for the investment made in Rubraca or other, approved PARP inhibitors, nor the true cost benefits of these precision-medicine therapies and their potential, long-term value to women with ovarian cancer, their families and physicians."
To hit a target of $100,000 per QALY, the discounts would obviously need to be bigger: Around 75% off for all three meds, ICER said.
The two PARP drugs approved for women whose disease has already come back after two rounds of prior therapy—Lynparza and Clovis Oncology’s Rubraca—are more cost-effective in that setting, ICER found. When based upon Lynparza's net price, in fact, the cost of that med came in below the $150,000 target, specifically in patients with the BRCA mutations.
Lynparza would require a discount of 35%, however, to fit the $100,000 threshold. Rubraca would need a cut of at least 50% for the $150,000 threshold and as much as 65%.
“[T]he findings of our analysis suggest that the PARP inhibitors of focus for this review would provide gains in quality-adjusted and overall survival over alternative therapies,” the group’s final appraisal states, “but are not currently priced in alignment with these benefits, with the exception of [Lynparza] in recurrent, BRCA-mutated ovarian cancer.”