Skip to main content
SpringerLink
Log in

The Budget Impact of Including Rucaparib on a US Payer Formulary for the Treatment of Patients with Metastatic Ovarian Cancer

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Objective

A budget impact model was constructed to assess the incremental budget impact that rucaparib availability would have on a US health plan.

Methods

An incremental budget impact was estimated over a 3-year horizon as the difference in total annual cost of treatment, with and without rucaparib available, for second-line maintenance, third-line treatment, and the combined maintenance and treatment settings. The hypothetical health plan includes one million covered lives, and commercial and Medicare lines of business. Alternative products included in the model were based on the National Comprehensive Cancer Network guidelines. The eligible patient population was estimated using an incidence-based approach. Modeled costs include drug acquisition, intravenous drug administration, required laboratory testing, and medical management of adverse events.

Results

In the maintenance setting, average total expenditures over 3 years were estimated to be US$1,465,043 with rucaparib versus US$1,461,350 without it as a treatment option; the average incremental budget impact was US$3693 (US$0.0003 per member per month [PMPM]). In the treatment setting, average total expenditures were estimated to be US$1,320,718 with rucaparib versus US$1,313,736 without it; the average incremental budget impact was US$6982 (US$0.0006 PMPM). Budget impact is smaller in commercial plans than Medicare because of the higher incidence of ovarian cancer in the over-65 population.

Conclusion

The budget impact of adding rucaparib to the formulary for a health plan adds negligible PMPM costs of < US$0.001 in all tested settings and scenarios due to the small population eligible for therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ward EM, Sherman RL, Henley SJ, Jemal A, Siegel DA, Feuer EJ, et al. Annual report to the nation on the status of cancer, featuring cancer in men and women age 20–49 years. J Natl Cancer Inst. 2019;111(12):1279–97.

    Article  Google Scholar 

  2. Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M, et al. SEER cancer statistics review, 1975-2016, based on November 2018 SEER data submission Bethesda, MD2019. 2018. https://seer.cancer.gov/csr/1975_2016/.

  3. Clovis Oncology. Rubraca® (rucaparib) tablets [prescribing information]. 2020.

  4. Coleman RL, Oza AM, Lorusso D, Aghajanian C, Oaknin A, Dean A, et al. Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390(10106):1949–61.

    Article  CAS  Google Scholar 

  5. Oza AM, Tinker AV, Oaknin A, Shapira-Frommer R, McNeish IA, Swisher EM, et al. Antitumor activity and safety of the PARP inhibitor rucaparib in patients with high-grade ovarian carcinoma and a germline or somatic BRCA1 or BRCA2 mutation: integrated analysis of data from Study 10 and ARIEL2. Gynecol Oncol. 2017;147(2):267–75.

    Article  CAS  Google Scholar 

  6. National Comprehensive Cancer Network. Ovarian cancer version 1. 2019.

  7. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health J Int Soc Pharmacoecon Outcomes Res. 2013;16(2):e1-5.

    Article  Google Scholar 

  8. Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, et al. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices–budget impact analysis. Value Health. 2007;10(5):336–47.

    Article  Google Scholar 

  9. Sullivan SD, Mauskopf JA, Augustovski F, Jaime Caro J, Lee KM, Minchin M, et al. Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value Health. 2014;17(1):5–14.

    Article  Google Scholar 

  10. Surveillance Epidemiology and End Results Program. Cancer Stat Facts: Prostate Cancer Bethesda, MD: National Cancer Institute. 2020. https://seer.cancer.gov/statfacts/html/ovary.html.

  11. Garofalo D, Verma-Kurvari S, Aydin E, Labrador M, Webster J, Brown G, et al. Real world data analysis of ovarian cancer (OC) maintenance utilization among maintenance eligible patients. American Society of Clinical Oncology (ASCO) Annual Congress; Chicago, IL. 2019.

  12. Karve S, Walker G, Wang R, Lawrence D, Horsfield A. Real-world treatment patterns among patients with ovarian cancer: an analysis of a large us electronic health records database. Value Health. 2016;19(7):A754.

    Article  Google Scholar 

  13. Pennington KP, Walsh T, Harrell MI, Lee MK, Pennil CC, Rendi MH, et al. Germline and somatic mutations in homologous recombination genes predict platinum response and survival in ovarian, fallopian tube, and peritoneal carcinomas. Clin Cancer Res. 2014;20(3):764–75.

    Article  CAS  Google Scholar 

  14. AstraZeneca. Lynparza® (olaparib) tablets [prescribing information]. 2018.

  15. Tesaro. Zejula® (niraparib) capsules [prescribing information]. 2019.

  16. Aghajanian C, Blank SV, Goff BA, Judson PL, Teneriello MG, Husain A, et al. OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol. 2012;30(17):2039–45.

    Article  CAS  Google Scholar 

  17. Domchek SM, Aghajanian C, Shapira-Frommer R, Schmutzler RK, Audeh MW, Friedlander M, et al. Efficacy and safety of olaparib monotherapy in germline BRCA1/2 mutation carriers with advanced ovarian cancer and three or more lines of prior therapy. Gynecol Oncol. 2016;140(2):199–203.

    Article  CAS  Google Scholar 

  18. Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, Gebski V, Heywood M, Vasey PA, et al. Pegylated liposomal doxorubicin and carboplatin compared with paclitaxel and carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol. 2010;28(20):3323–9.

    Article  CAS  Google Scholar 

  19. Ferrandina G, Ludovisi M, Lorusso D, Pignata S, Breda E, Savarese A, et al. Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol. 2008;26(6):890–6.

    Article  CAS  Google Scholar 

  20. Gordon AN, Fleagle JT, Guthrie D, Parkin DE, Gore ME, Lacave AJ. Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol. 2001;19(14):3312–22.

    Article  CAS  Google Scholar 

  21. Mutch DG, Orlando M, Goss T, Teneriello MG, Gordon AN, McMeekin SD, et al. Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol. 2007;25(19):2811–8.

    Article  CAS  Google Scholar 

  22. Parmar MK, Ledermann JA, Colombo N, du Bois A, Delaloye JF, Kristensen GB, et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet (London, England). 2003;361(9375):2099–106.

    Article  CAS  Google Scholar 

  23. Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ, et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol. 2006;24(29):4699–707.

    Article  CAS  Google Scholar 

  24. Rose PG, Blessing JA, Ball HG, Hoffman J, Warshal D, DeGeest K, et al. A phase II study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2003;88(2):130–5.

    Article  CAS  Google Scholar 

  25. Sehouli J, Stengel D, Harter P, Kurzeder C, Belau A, Bogenrieder T, et al. Topotecan weekly versus conventional 5-day schedule in patients with platinum-resistant ovarian cancer: a randomized multicenter phase II trial of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. J Clin Oncol. 2011;29(2):242–8.

    Article  CAS  Google Scholar 

  26. Coleman RL, Brady MF, Herzog TJ, Sabbatini P, Armstrong DK, Walker JL, et al. Bevacizumab and paclitaxel-carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG Oncology/Gynecologic Oncology Group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2017;18(6):779–91.

    Article  CAS  Google Scholar 

  27. Pujade-Lauraine E, Hilpert F, Weber B, Reuss A, Poveda A, Kristensen G, et al. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase III trial. J Clin Oncol. 2014;32(13):1302–8.

    Article  CAS  Google Scholar 

  28. Katsumata N, Yasuda M, Takahashi F, Isonishi S, Jobo T, Aoki D, et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009;374(9698):1331–8.

    Article  CAS  Google Scholar 

  29. Rose PG, Blessing JA, Mayer AR, Homesley HD. Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 1998;16(2):405–10.

    Article  CAS  Google Scholar 

  30. Micromedex Solutions. Red book online Truven Health Analytics2019. https://www.micromedexsolutions.com/micromedex2/librarian/.

  31. Genentech. Avastin® (bevacizumab) for injection [prescribing information]. 2019.

  32. Eli Lilly and Company. Gemzar® (gemcitabine) for injection [prescribing information]. 2019.

  33. Mylan Institutional LLC. Carboplatin injection [prescribing information]. 2014.

  34. Mylan Pharmaceuticals Inc. Etoposide capsule [prescribing information]. 2016.

  35. WG Critical Care, LLC. Paclitaxel injection [prescribing information]. 2015.

  36. WG Critical Care, LLC. Cisplatin injection [prescribing information]. 2015.

  37. Centers for Medicare & Medicaid Services. Medicare physician fee schedule. 2019.

  38. Khorana AA, Dalal MR, Lin J, Connolly GC. Health care costs associated with venous thromboembolism in selected high-risk ambulatory patients with solid tumors undergoing chemotherapy in the United States. Clinicoecon Outcomes Res. 2013;5:101–8.

    Article  Google Scholar 

  39. U.S. Department of Health & Human Services. Healthcare cost and utilization project: free healthcare statistics. Rockville: U.S. Department of Health & Human Services; 2019.

    Google Scholar 

  40. Fox W, Pickering J. Hospital & physician cost shift: payment level comparisons of Medicare, Medicaid, and commercial payers. 2008.

  41. Centers for Medicare & Medicaid Services. Medicare clinical laboratory fee schedule. 2019.

  42. Poonawalla IB, Parikh RC, Du XL, VonVille HM, Lairson DR. Cost effectiveness of chemotherapeutic agents and targeted biologics in ovarian cancer: a systematic review. Pharmacoeconomics. 2015;33(11):1155–85.

    Article  Google Scholar 

  43. Centers for Medicare & Medicaid Services. Table 23 national health expenditures; nominal dollars, real dollars, price indexes, and annual percent change: selected calendar years 1980-2017. 2019.

  44. Neeser K, O’Neil WM, Stern L, Harrow B, Travers K. Budget impact of niraparib as maintenance treatment in recurrent ovarian cancer following platinum-based chemotherapy. J Comp Eff Res. 2019;8(8):577–87.

    Article  Google Scholar 

  45. Guy H, Walder L, Fisher M. Cost-effectiveness of niraparib versus routine surveillance, olaparib and rucaparib for the maintenance treatment of patients with ovarian cancer in the United States. Pharmacoeconomics. 2019;37(3):391–405.

    Article  Google Scholar 

  46. Wallace K, Goble S, Isaacson J, Maloney L, Cameron T, Bedel J. Comment on: cost-effectiveness of niraparib versus routine surveillance, olaparib and rucaparib for the maintenance treatment of patients with ovarian cancer in the United States. Pharmacoeconomics. 2019;37(8):1065–7.

    Article  Google Scholar 

  47. Wolford JE, Bai J, Moore KN, Kristeleit R, Monk BJ, Tewari KS. Cost-effectiveness of niraparib, rucaparib, and olaparib for treatment of platinum-resistant, recurrent ovarian carcinoma. Gynecol Oncol. 2020;157(2):500–7.

    Article  CAS  Google Scholar 

  48. Swisher EM, Lin KK, Oza AM, Scott CL, Giordano H, Sun J, et al. Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 Part 1): an international, multicentre, open-label, phase 2 trial. Lancet Oncol. 2017;18(1):75–87.

    Article  CAS  Google Scholar 

  49. Janssen Products LP. Doxil® (doxorubicin hydrochloride liposome injection) [prescribing information]. 2017.

  50. Novartis Pharmaceuticals Corporation. Hycamtin® (topotecan) for injection [prescribing information]. 2018.

  51. Cipla USA Inc. Cyclophosphamide capsules [prescribing information]. 2018.

  52. Markman M, Liu PY, Wilczynski S, Monk B, Copeland LJ, Alvarez RD, et al. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol. 2003;21(13):2460–5.

    Article  CAS  Google Scholar 

  53. Rose PG. Gemcitabine reverses platinum resistance in platinum-resistant ovarian and peritoneal carcinoma. Int J Gynecol Cancer. 2005;15(Suppl 1):18–22.

    Article  Google Scholar 

  54. Gordon AN, Tonda M, Sun S, Rackoff W. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol. 2004;95(1):1–8.

    Article  CAS  Google Scholar 

  55. Hospira Inc. Docetaxel [prescribing information]. 2018.

Download references

Acknowledgements

Editorial assistance funded by Clovis Oncology, Inc., was provided by Shelly Lim and Frederique H. Evans of Ashfield Healthcare Communications.

Author information

Authors and Affiliations

  1. Clovis Oncology, Inc., Health Economics and Outcomes Research, 5500 Flatiron Pkwy, Boulder, CO, 80301, USA

    Katrine Wallace & Ashwini Pai

  2. Analysis Group, Inc., Health Care Group, 1010 El Camino Real, Suite 310, Menlo Park, CA, 94025, USA

    Kelly Adamski, Darya Rose & Anita Chawla

Authors
  1. Katrine Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly Adamski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashwini Pai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Darya Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anita Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katrine Wallace.

Ethics declarations

Funding

This study was funded by Clovis Oncology, Inc., and was designed and conducted by the funder.

Conflict of interest

Katrine Wallace and Ashwini Pai are employees of Clovis Oncology, Inc., and may own stock or have stock options in that company. Kelly Adamski and Anita Chawla are employees of Analysis Group, which received consulting fees from Clovis Oncology. Darya Rose is a previous employee of Analysis Group.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Author Contributions

KW directed the project, provided all cost and epidemiology inputs for the model, and wrote the manuscript. KA, DR, and AC developed the methodology and programming and constructed the model. AP provided all clinical data inputs for the model. All authors reviewed and contributed to revisions of the manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 86 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wallace, K., Adamski, K., Pai, A. et al. The Budget Impact of Including Rucaparib on a US Payer Formulary for the Treatment of Patients with Metastatic Ovarian Cancer. PharmacoEconomics 39, 231–241 (2021). https://doi.org/10.1007/s40273-020-00970-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-020-00970-y

Search

Navigation