Healthcare resource use in the management of advanced epithelial ovarian cancer in Canada.

Abstract

e17565 Background: Treatment selection for recurrent advanced epithelial ovarian cancer (EOC) depends on sensitivity to platinum-based chemotherapy (PBC), with patients being categorized as platinum-sensitive or platinum-resistant ovarian cancer (PSOC and PROC, respectively). While most patients initially respond to PBC, resistance often develops resulting in limited treatment options and poor prognosis. Managing advanced EOC requires long-term, intensive treatment and monitoring. However, no Canadian data on healthcare resource utilization (HCRU) costs reflect the current market for managing advanced EOC. Mirvetuximab soravtansine (MIRV), a new therapy intended to treat patients with folate receptor alpha positive PROC, showed a significant benefit over chemotherapy in the MIRASOL trial. The current study aimed to estimate the Canadian HCRU cost for managing advanced EOC, including PSOC and PROC. The secondary objective was to assess the HCRU costs of MIRV versus current PROC therapies, to inform key stakeholders in healthcare decision-making. Methods: A costing analysis was developed via a decision tree to assess the treatment pathway of patients as they remain PSOC or develop PROC. Based on consensus from Canadian clinicians, an average of three lines of therapy (LOT) was assumed for PSOC patients, based on front-line response (front-line PSOC), including patients eventually developing platinum resistance. For PROC patients based on front-line response (front-line PROC), two LOTs were assumed. PSOC treatments included PBC and maintenance while PROC included bevacizumab+chemotherapy and single-agent chemotherapies. Pretreatment, administration, monitoring, adverse events grade ≥3 at a frequency of >5%, inpatient and emergency visits, and end-of-life costs were included. Drug acquisition costs were excluded to assess disease management costs. Model inputs were derived from product labels and validated by Canadian clinicians to reflect current practice. A societal perspective was also assessed. Results: Patients with PSOC who remained platinum-sensitive incurred $73,350 HCRU costs compared to $71,140 for front-line PROC patients. For patients who develop platinum resistance in later LOT, HCRU costs ranged between $68,107 and $75,786. The cost variation was mainly driven by increased monitoring for PSOC, increased disease-related complications for PROC, as well as the average number of LOT patients received due to differences in prognosis. Among PROC therapies, MIRV was associated with a minimal increase in HCRU costs compared to single-agent chemotherapies (Δ: +$987 to +$1,513) but reduced HCRU costs compared to the most commonly used treatment, bevacizumab + chemotherapy (Δ: -$9 to -$2,537). Conclusions: Advanced EOC is associated with a significant HCRU burden in Canada. Based on this model, introducing MIRV may reduce or, at minimum, prevent further increases in this burden.