Patients diagnosed with early-stage ovarian cancer who are treated with novel targeted therapies may experience better overall survival and less financial toxicity compared with those who have late-stage disease.
Utilizing novel targeted therapies such as olaparib (Lynparza) as a treatment for patients with newly diagnosed ovarian cancer may help to offset costs and improve survival, according to a study published in the Journal of Health Economics and Outcomes Research.
Findings from the study indicated that the only required treatment for 74% of patients with stage I disease, and 54% with stage II disease received first-line platinum chemotherapy. Among those with more advanced disease, 24% of patients with stage III disease and 20% with stage IV disease did not receive treatment after first-line therapy. For the entire cohort, the median overall survival (OS) was 5.13 years, with survival being the highest for those with earlier stage disease and significantly lower in the advanced stage. The median OS was not reached for stage I and II disease, but for stage III the median OS was 4.09 years, and stage IV it was 3.47 years. The overall mean cost for patients with stage I disease was CAD $58,099, stage II disease was CAD $71,455, stage III was CAD $114,713, and stage IV was CAD $124,20.
“Advanced [ovarian cancer] is associated with poor survival and increased costs, mainly driven by hospitalizations or cancer clinic visits. The majority of [patients with ovarian cancer] in our study were diagnosed with stage III or IV disease at diagnosis. The introduction of new targeted therapies, such as olaparib based on the results of the [phase 3] SOLO-1 trial [NCT01844986], could impact health system costs, especially those associated with advanced disease by offsetting higher downstream costs such as costly hospitalizations, while also improving survival,” the study’s investigators wrote.
During the study period, 6221 women were diagnosed with ovarian cancer, and 2539 were included in the analysis. Patients who did not have surgery within 1 year of diagnosis, did not undergo platinum-based therapy as a first-line treatment, received another previous cancer diagnosis, and were non-residency or had less than 1-year of follow-up were not included in the study. At diagnosis, the mean age was 60.4 years, and almost all patients had stage III disease (n = 1247). In total, 96.3% of patients were reported to have cancer of the ovary, almost all of whom had epithelial histology (93.2%). Ovarian debulking surgery was performed in 42.9% of patients.
The mean time from diagnosis to the start of treatment was 3.14 months plus or minus 7.22 months. Throughout the cohort, patients received first-line platinum-based therapy either as a combination regimen or monotherapy.
Survival was compared between, with investigators reporting statistical significance in stage I to III, I to IV, II to III, and II to IV (P <.0001). Investigators reported that the 5-year survival rate for stage I disease was 89%, stage II was 76%, stage III was 42%, and stage IV was 33%, with missing. Forty four percent of patients were missing their stage.
The time to first subsequent treatment from first line to second line was 13.5 months for stage I disease and 14.9 months for stage II disease. Patients with stage III or IV disease had a mean estimated time to first subsequent treatment of 11.2 months and 8.7 months, respectively.
For all patients with ovarian cancer, the total cost throughout the study period was CAD $258 million, which translated to a mean cost per patients of CAD $101,707 plus or minus $69,997. In the matched controls, which included 12,695 patients, the overall total cost was CAD $504 million, and a mean cost per patient of CAD $39,693 plus or minus CAD $89,396, which translated to a mean cost per patient of CAD $62,014 attributable to ovarian cancer.
Hurry M, Hassan S, Seung SJ, Walton RN, Elnoursi A, McGee JD. Real-world treatment patterns, survival, and costs for ovarian cancer in Canada: a retrospective cohort study using provincial administrative data. J Health Econ Outcomes Res. 2021;8(2):114-121. doi:10.36469/jheor.2021.29145