Cost-Utility Analysis of First-Line Olaparib plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer in China after Volume-Based Procurement

OBJECTIVE

To evaluate the cost-utility and 5-year budget impact of first-line olaparib plus abiraterone versus abiraterone alone for metastatic castration-resistant prostate cancer (mCRPC) in China after the eleventh round of volume-based procurement (VBP). The intention-to-treat (ITT) population was assigned primary decision-analytic weight; the prespecified BRCA1/2-mutated (BRCAm) subgroup was a supporting analysis.

METHODS

A three-state partitioned survival model was built from the Chinese healthcare payer perspective over a 15-year horizon (5% discounting). ITT control-arm survival curves were reconstructed via the Guyot algorithm; the BRCAm control-arm survival curve was median-anchored to the published 23.0-month median. Utilities came from an mCRPC EQ-5D meta-analysis and a Chinese source, valued using the Chinese EQ-5D value set. Post-VBP prices were applied. A Markov model, probabilistic sensitivity analysis, and value-of-information analysis were performed.

RESULTS

The ITT incremental cost-effectiveness ratio (ICER) was CNY 40,198/ QALY (meta-analytic utilities) and CNY 43,721/QALY (Chinese utilities), below the CNY 287,247/QALY willingness-to-pay threshold (3× GDP). The BRCAm ICER was CNY 54,708/QALY and CNY 68,000/QALY, stable across the full OS hazard-ratio confidence interval and conservative survival-cap scenarios. All estimates remained cost-effective under a Markov structure (maximum CNY 120,558/QALY). Probabilistic cost-effectiveness exceeded 99.9%; population expected value of perfect information was zero. The 5-year budget impact was CNY 46.57 million.

CONCLUSIONS

At post-VBP prices, first-line olaparib plus abiraterone is cost-effective, robust across utility sources, survival distributions, and model structures. The BRCAm subgroup shows a hypothesis-consistent signal. These findings support National Reimbursement Drug List inclusion, particularly for the NMPA-approved BRCAm indication, contingent on adequate BRCA testing capacity.

HIGHLIGHTS

• This is the first cost-utility analysis of first-line olaparib plus abiraterone for mCRPC in China at post-volume-based-procurement prices, addressing a gap left by prior pre-VBP Chinese evaluations.

• The combination is cost-effective across the intention-to-treat and BRCA1/2-mutated populations, robust to utility sources, survival distributions, model structures, and sensitivity analyses, with negligible decision uncertainty at the current willingness-to-pay threshold.

• Findings support National Reimbursement Drug List inclusion, particularly for the NMPA-approved BRCAm indication, contingent on strengthening BRCA testing capacity in tier-2 and tier-3 hospitals.