Use of individualized starting dose and niraparib hematologic adverse event management costs in ovarian cancer

Aim: To understand the impact of the niraparib individualized starting dose (ISD), compared with fixed starting dose (FSD), on the cost of hematologic adverse event (AE) management from a US payer perspective. Methods: The frequencies of grade ≥3 hematologic AEs that occurred in >1% of patients treated with niraparib were obtained from the primary analysis results of the phase III PRIMA/ENGOTOV26/ GOG-3012 trial. US unit costs for each grade ≥3 AE in the base case were obtained from the 2017 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project database; unit costs were adjusted to 2020 US dollars. AE management costs per patient were calculated by multiplying AE unit cost by the frequency of each AE by niraparib starting dose. Because AEs were assumed to occur independently of one another, costs were added to derive the total cost. Results: For niraparib, the estimated AEmanagement cost per patient was lower for the ISD than the FSD for all hematologic AEs (FSD vs ISD: thrombocytopenia, $4701.87 vs $1921.89; anemia, $2784.00 vs $1760.59; platelet count decreased, $2103.47 vs $922.51; neutropenia, $2112.50 vs $1369.56; neutrophil count decreased, $1285.87 vs $770.38). The total mean calculated AE management cost per patient was $12,987.71 with the FSD and $6744.93 with the ISD. Conclusion: For niraparib, the cost of managing hematologic AEs in the US was reduced by almost halfwith the ISD comparedwith the FSD. The cost reduction and improvements in safety associated with the niraparib ISD support its use in clinical practice. Plain language summary.: How using an individualized dose of niraparib influences the cost of managing blood cell-related side effects. What is this article about?: Patients with newly diagnosed advanced ovarian cancer that responds to platinum-based chemotherapy may receive niraparib maintenance therapy to extend the time before the cancer comes back or gets worse. The niraparib starting dose can be fixed (same amount for everyone) or individualized based on body weight and platelet count. What were the results?: In this US-based analysis, using the niraparib individualized starting dose (ISD) reduced the cost of managing blood cell-related side effects compared with using the fixed starting dose (FSD). What do the results mean?: Using the niraparib ISD reduced the cost of managing blood cell-related side effects compared with the FSD. Results of other past studies have also shown that using the niraparib ISD can reduce side effects and can treat the cancer just as effectively, when compared with the FSD. Along with the results of those past studies, the cost reductions observed in this study support using the niraparib ISD as maintenance therapy in patients with newly diagnosed advanced ovarian cancer that responds to platinum-based chemotherapy. Shareable abstract: Researchers of the US-based analysis found that niraparib dosing based on patient body weight and platelet count was associated with nearly 50% lower costs for managing hematologic adverse events, compared with the fixed starting dose, for first-line maintenance treatment of patients with advanced epithelial ovarian cancer. These findings highlight the cost reduction and safety improvements associated with individualized starting doses of niraparib, further supporting its use in clinical practice.