Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Table 3

Economic analysis results.

	Olara + Dox	AIM	MAID	GemDoc (Maki)	PLD	GemDoc (GeDDiS)	Dox
Base-case results
Median PFS^a (months)	6.5	6.0	6.0	3.9	3.9	2.8	3.9
Median OS^a (months)	24.0	14.3	14.3	11.5	11.5	12.0	11.5
10-year survival (%)	9.5	4.7	4.7	5.0	5.0	2.9	5.0
Mean LYs (95% CrI)	3.37 (2.53–4.36)	2.17 (1.24–3.44)	2.17 (1.26–3.35)	2.10 (1.55–2.96)	2.10 (1.53–2.98)	1.69 (0.91–2.85)	2.10 (1.55–2.94)
Mean total expected lifetime cost ($) (per patient (95% CrI))	182,984 (157,673–207,429)	122,166 (106,753–138,696)	104,787 (90,428–119,603)	83,473 (69,478–99,681)	53,925 (44,335–65,606)	50,976 (43,686–59,751)	49,330 (43,058–58,480)
Incremental cost ($) (per LY^b)
Each comparator versus Dox	105,408	1,064,437	810,457	Dominated	Dominated	Dominated	Reference
Fully incremental, each comparator versus previous nondominated alternative	105,408	Dominated	Extendedly dominated	Dominated	Dominated	Dominated	NA
Pairwise, Olara + Dox versus each comparator (per LY)	—	50,701	65,189	78,480	101,784	78,679	105,408
Secondary analysis
Mean QALYs per patient (95% CrI)	1.86 (1.40–2.42)	1.21 (0.73–1.89)	1.21 (0.74–1.83)	1.17 (0.88–1.63)	1.17 (0.87–1.64)	0.94 (0.54–1.57)	1.17 (0.87–1.61)
Incremental cost ($) (per QALY)
Each comparator versus Dox	196,309	1,841,157	1,642,925	Dominated	Dominated	Dominated	Reference
Fully incremental, each comparator versus previous nondominated alternative	196,309	Extendedly dominated	Extendedly dominated	Dominated	Dominated	Dominated	NA
Pairwise, Olara + Dox versus each comparator (per QALY)	—	94,839	120,846	145,447	189,147	143,732	196,309

AIM = ifosfamide + doxorubicin + mesna; CrI = credible interval (within which 95% of probabilistic simulations were observed); Dox = doxorubicin; GemDoc = gemcitabine + docetaxel; ICER = incremental cost-effectiveness ratio; LY = life-year; MAID = mesna + doxorubicin + ifosfamide + dacarbazine; NA = not applicable; Olara + Dox = olaratumab + doxorubicin; OS = overall survival; PFS = progression-free survival; PLD = pegylated liposomal doxorubicin; QALY = quality-adjusted life year. Cost and outcomes (with the exception of median PFS, OS and 10-year survival) are discounted at 3%. ^aCalculated from the survival functions used in the model. ^bDominated: a dominated intervention is defined as an intervention with higher costs and worse outcomes than an alternative intervention. Extendedly dominated: in a fully incremental analysis, a treatment is said to be extendedly dominated when the treatment’s ICER is higher than the ICER of the next, more effective, alternative (i.e., the given treatment is dominated by the combination of two alternatives and should not be used to calculate appropriate ICERs). For example, consider that there are three drug regimens, A, B, and C, with regimen C being more effective (resulting in greater LYs) and more costly than regimen B and regimen B being more effective (resulting in greater LYs) and more costly than regimen A. Drug regimen C is said to extendedly dominate drug regimen B if the ICER for drug regimen C when compared with drug regimen A is more favorable (has a lower value) than the ICER for drug regimen B when compared with drug regimen A.