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Background <p>Emerging evidence supports the clinical potential of immune checkpoint inhibitors (ICIs) with or without bevacizumab and poly-(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for refractory advanced ovarian cancer (AOC) with BRCA non-mutated (non-BRCAm) and homologous recombination deficiency-negative (HRD-negative). However, broader adoption hinges on a thorough economic evaluation.</p> Methods <p>A lifetime Markov model was developed to assess the cost-effectiveness of six first-line treatment strategies for AOC in non-BRCAm/HRD-negative patients: chemotherapy alone (C); bevacizumab plus chemotherapy (BC); durvalumab plus chemotherapy and bevacizumab with or without olaparib (DBC or DBCO); and pembrolizumab plus chemotherapy with or without olaparib (PC or PCO). Model inputs were informed by patient demographics and clinical outcomes reported in the DUO-O and KEYLYNK-001 trials, as well as aggregated cost data relevant to the American healthcare system. Primary outcomes included incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) at the willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life year (QALY).</p> Results <p>Compared to C, the ICERs (with INHBs) for BC, DBC, DBCO, PC, and PCO were $2,632,524/QALY (-0.73 QALY), $2,005,771/QALY (-1.73 QALY), $7,351,200/QALY (-2.88 QALY), $484,706/QALY (-1.46 QALY), and $1,382,130/QALY (-2.46 QALY), respectively. The comparison among ICI-based treatment regimens revealed that PC had high efficacy and low cost compared with DBCO and PCO, and the ICER of PC versus DBC was $69,253/QALY.</p> Conclusions <p>None of the ICI-based or BC proved cost-effective versus C for newly diagnosed AOC with non-BRCAm/HRD-negative. However, PC offers a cost-effective alternative when compared with other ICI-based strategies.</p>

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Immune checkpoint inhibitors-based therapies for first-line treatment of advanced ovarian cancer with non-BRCAm/HRD-negative: a cost-effectiveness analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月28日

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  • Youwen Zhu,
  • Xiaofang Zhou,
  • Kun Liu,
  • Hong Zhu

摘要

Background

Emerging evidence supports the clinical potential of immune checkpoint inhibitors (ICIs) with or without bevacizumab and poly-(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for refractory advanced ovarian cancer (AOC) with BRCA non-mutated (non-BRCAm) and homologous recombination deficiency-negative (HRD-negative). However, broader adoption hinges on a thorough economic evaluation.

Methods

A lifetime Markov model was developed to assess the cost-effectiveness of six first-line treatment strategies for AOC in non-BRCAm/HRD-negative patients: chemotherapy alone (C); bevacizumab plus chemotherapy (BC); durvalumab plus chemotherapy and bevacizumab with or without olaparib (DBC or DBCO); and pembrolizumab plus chemotherapy with or without olaparib (PC or PCO). Model inputs were informed by patient demographics and clinical outcomes reported in the DUO-O and KEYLYNK-001 trials, as well as aggregated cost data relevant to the American healthcare system. Primary outcomes included incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) at the willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life year (QALY).

Results

Compared to C, the ICERs (with INHBs) for BC, DBC, DBCO, PC, and PCO were $2,632,524/QALY (-0.73 QALY), $2,005,771/QALY (-1.73 QALY), $7,351,200/QALY (-2.88 QALY), $484,706/QALY (-1.46 QALY), and $1,382,130/QALY (-2.46 QALY), respectively. The comparison among ICI-based treatment regimens revealed that PC had high efficacy and low cost compared with DBCO and PCO, and the ICER of PC versus DBC was $69,253/QALY.

Conclusions

None of the ICI-based or BC proved cost-effective versus C for newly diagnosed AOC with non-BRCAm/HRD-negative. However, PC offers a cost-effective alternative when compared with other ICI-based strategies.