Cost-effectiveness of durvalumab with or without olaparib as a first-line treatment for dMMR type of advanced/recurrent endometrial cancer
In the phase III DUO-E trial, durvalumab with or without olaparib significantly increased survival outcomes compared to chemotherapy alone among patients with endometrial cancer. The aim of this study was to assess the cost-effectiveness of durvalumab in patients with advanced/recurrent dMMR endometrial cancer. A Markov model was used to compare the cost-effectiveness of durvalumab with or without olaparib compared to chemotherapy alone in the treatment of advanced/recurrent dMMR endometrial cancer, using the data from phase III DUO-E trial. The outcomes evaluated were total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). One-way sensitivity and probabilistic sensitivity analyses were performed to account for uncertainty. The base case analysis found that durvalumab and chemotherapy had an ICER of $239,884/QALY, whereas durvalumab with olaparib and chemotherapy had an ICER of $259,651/QALY compared to chemotherapy alone. The model was most sensitive to the cost of durvalumab. Probabilistic sensitivity analysis revealed that durvalumab had a 0% likelihood of being considered cost effective at a WTP threshold of $150,000 per QALY. Durvalumab was not cost-effective as a first-line treatment of patients with advanced/recurrent dMMR subtype of endometrial cancer. Reducing the cost of durvalumab might improve economic outcomes.