Abstract
BACKGROUND: Patients with advanced ovarian cancer (AOC) who are BRCA wild-type (BRCAwt) or exhibit low loss of heterozygosity (LOH-low) typically face a poor prognosis and have limited therapeutic options. Pembrolizumab plus chemotherapy followed by maintenance with or without olaparib (PCO or PC) brings new hope to these patients. However, the substantial financial burden associated with these regimens necessitates a thorough cost-effectiveness evaluation. METHODS: The 20-year horizon Markov model with three health states was developed using clinical data from the KEYLYNK-001 trial and associated treatment costs to estimate the lifetime costs and health benefits of PCO, PC, and chemotherapy. Primary outcomes included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds of $150,000/QALY for the USA and $39,695/QALY for China. RESULTS: In the USA, the total costs and QALYs were $934,191 and 4.74 for PC, and $521,690 and 4.02 for chemotherapy. The corresponding ICERs were $568,586/QALY in the general population and $399,919/QALY among those with programmed cell death ligand 1 combined positive scores (PD-L1 CPS) ≥ 10. In China, PC and chemotherapy incurred costs of $126,542 and $106,247, with QALYs of 4.27 and 3.68, respectively. The ICERs were $34,032/QALY overall and $18,462/QALY in the PD-L1 CPS ≥ 10 population. In both countries, PCO yielded higher costs but lower effectiveness compared to PC. CONCLUSIONS: In BRCAwt AOC patients with LOH-low, PC is a cost-effective first-line treatment compared to PCO in both the USA and China, particularly among PD-L1 CPS ≥ 10 population.