Economic evaluation alongside the PAOLA-1 /ENGOT-ov25 trial: cost of ovarian cancer and cost-effectiveness of olaparib plus bevacizumab first-line maintenance
10 affiliations
- 1Centre Léon Bérard, CNRS, Université Lumière Lyon 2, Université Jean Monnet Saint-Etienne, Emlyon Business School, GATE, Lyon, 69008 France
- 2Centre Léon Bérard, DRCI, 28 rue Laennec, Lyon, F-69008 France
- 3Hôpital de l’Hôtel Dieu, DRCI-URCEco, AP-HP, Paris, F-75004 France
- 4Klinikum der Universität München, München, Germany
- 5AGO Study group, Taufkirchen, Germany
- 6National Cancer Institute IRCCS Fondazione G. Pascale and MITO, Naples, Italy
- 7Hospital Central de Asturias and GEICO, Oviedo, Spain
- 8Centre Oscar Lambret, GINECO (Paris), Lille, France
- 9Université Paris Est Créteil, Créteil, France
- 10Centre Léon Bérard, University Claude Bernard Lyon I, GINECO (Paris), Lyon, France
Abstract
Objectives: The PAOLA-1 trial randomized 806 patients with newly diagnosed advanced ovarian cancer to olaparib plus bevacizumab or placebo plus bevacizumab and demonstrated a progression-free survival (PFS) and overall survival (OS) benefit when maintenance olaparib was added to bevacizumab in patients with a positive tumor homologous recombination deficiency (HRD) test. We conducted an economic evaluation based on patient-level data from the PAOLA-1 trial.
Methods: Costs were assessed from the French health care system perspective with a 60-month time horizon. Individual healthcare consumptions were collected from the case report forms. Survival analysis was conducted using restricted mean survival time (RMST). Health-related quality of life (HRQoL) was measured using the EQ-5D-5L questionnaire. Costs and HRQoL were discounted at 2.5% rate. Incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses were performed.
Results: Mean costs per patient were €90,972 (SD: 55,229) in the ITT population (N = 806) and €96,054 (SD: 56,270) in the HRD-positive population (N = 387). In the latter, mean costs per patient were €109,895 (SD: 49,234) in the olaparib plus bevacizumab group (255/387) and €69,316 (SD: 59,468) in the placebo plus bevacizumab group (132/387). Mean Progression-free survival (PFS) were 3.375 (SD: 0.108) and 2.058 (SD: 0.140) years, respectively, leading to an ICER of €30,750 per Progression-free life-year gained (PF-LYG). Mean Overall survival (OS) were 4.208 (SD: 0.080) in the olaparib plus bevacizumab group and 3.875 (SD: 0.124) years in the placebo plus bevacizumab group. ICER was €121,088 per Life-year gained (LYG). Mean quality-adjusted life-year (QALY) were 3,775 (SD: 1,101) and 3,442 (SD: 1,094) years, respectively, leading to an ICER of €121,577 per QALY gained. The probability of olaparib plus bevacizumab being cost-effective was 29.9% at €100,000 level of willingness to pay per LYG and 24.3% per QALY gained.
Conclusions: In the HRD-positive population the ICER is exceeding international standards at the usually accepted willingness to pay thresholds. However, it can be considered acceptable in light of the statistical value for QALY that has been calculated in the French setting or based on a threshold amounting to two to three times the gross domestic product (GDP) per capita per QALY gained.
ClinicalTrials.gov identifier: NCT02477644 (date of registration: 2015-06-18).
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12962-026-00810-4.
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BibTeX
@article{perrier2026economic,
title = {{Economic evaluation alongside the PAOLA-1 /ENGOT-ov25 trial: cost of ovarian cancer and cost-effectiveness of olaparib plus bevacizumab first-line maintenance}},
author = {Lionel Perrier and Kevin Zarca and Thomas Cadet and Magali Morelle and Claire Cropet and Alexandre Burges and Sabrina Chiara Cecere and Isabel Palacio and Cyril Abdeddaim and Isabelle Durand-Zaleski and Isabelle Ray-Coquard},
journal = {Cost Effectiveness and Resource Allocation : C/E},
year = {2026},
month = aug,
doi = {10.1186/s12962-026-00810-4},
url = {https://doi.org/10.1186/s12962-026-00810-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Economic evaluation alongside the PAOLA-1 /ENGOT-ov25 trial: cost of ovarian cancer and cost-effectiveness of olaparib plus bevacizumab first-line maintenance
AU - Lionel Perrier
AU - Kevin Zarca
AU - Thomas Cadet
AU - Magali Morelle
AU - Claire Cropet
AU - Alexandre Burges
AU - Sabrina Chiara Cecere
AU - Isabel Palacio
AU - Cyril Abdeddaim
AU - Isabelle Durand-Zaleski
AU - Isabelle Ray-Coquard
PY - 2026
DA - 2026/08/06
JO - Cost Effectiveness and Resource Allocation : C/E
DO - 10.1186/s12962-026-00810-4
UR - https://doi.org/10.1186/s12962-026-00810-4
AB - Objectives: The PAOLA-1 trial randomized 806 patients with newly diagnosed advanced ovarian cancer to olaparib plus bevacizumab or placebo plus bevacizumab and demonstrated a progression-free survival (PFS) and overall survival (OS) benefit when maintenance olaparib was added to bevacizumab in patients with a positive tumor homologous recombination deficiency (HRD) test. We conducted an economic evaluation based on patient-level data from the PAOLA-1 trial. Methods: Costs were assessed from the French health care system perspective with a 60-month time horizon. Individual healthcare consumptions were collected from the case report forms. Survival analysis was conducted using restricted mean survival time (RMST). Health-related quality of life (HRQoL) was measured using the EQ-5D-5L questionnaire. Costs and HRQoL were discounted at 2.5% rate. Incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses were performed. Results: Mean costs per patient were €90,972 (SD: 55,229) in the ITT population (N = 806) and €96,054 (SD: 56,270) in the HRD-positive population (N = 387). In the latter, mean costs per patient were €109,895 (SD: 49,234) in the olaparib plus bevacizumab group (255/387) and €69,316 (SD: 59,468) in the placebo plus bevacizumab group (132/387). Mean Progression-free survival (PFS) were 3.375 (SD: 0.108) and 2.058 (SD: 0.140) years, respectively, leading to an ICER of €30,750 per Progression-free life-year gained (PF-LYG). Mean Overall survival (OS) were 4.208 (SD: 0.080) in the olaparib plus bevacizumab group and 3.875 (SD: 0.124) years in the placebo plus bevacizumab group. ICER was €121,088 per Life-year gained (LYG). Mean quality-adjusted life-year (QALY) were 3,775 (SD: 1,101) and 3,442 (SD: 1,094) years, respectively, leading to an ICER of €121,577 per QALY gained. The probability of olaparib plus bevacizumab being cost-effective was 29.9% at €100,000 level of willingness to pay per LYG and 24.3% per QALY gained. Conclusions: In the HRD-positive population the ICER is exceeding international standards at the usually accepted willingness to pay thresholds. However, it can be considered acceptable in light of the statistical value for QALY that has been calculated in the French setting or based on a threshold amounting to two to three times the gross domestic product (GDP) per capita per QALY gained. ClinicalTrials.gov identifier: NCT02477644 (date of registration: 2015-06-18). Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12962-026-00810-4.
SN - 1478-7547
ER -