Highlights
- •A survey was conducted to elicit the preferences of women with ovarian cancer for risks and benefits of PARP inhibitors.
- •Overall survival benefit and anticipated out of pocket costs most highly influenced women's choices.
- •Women expected at least 3–4 months of PFS in exchange for minimal side effects from taking a PARP inhibitor.
Abstract
Objective
To measure preferences of women with ovarian cancer regarding risks, side effects,
costs and benefits afforded by maintenance therapy (MT) with a poly ADP ribose polymerase
(PARP) inhibitor.
Methods
A discrete-choice experiment elicited preferences of women with ovarian cancer regarding
6 attributes (levels in parentheses) relevant to decisions for MT versus treatment
break: (1) overall survival (OS; 36, 38, 42 months); (2) progression-free survival
(PFS; 15, 17, 21 months); (3) nausea (none, mild, moderate); (4) fatigue (none, mild,
moderate); (5) probability of death from myelodysplastic syndrome/acute myelogenous
leukemia (MDS/AML; 0% to 10%); (6) monthly out-of-pocket cost ($0 to $1000). Participants
chose between 2 variable MT scenarios and a static scenario representing treatment
break, with multiple iterations. Random-parameters logit regression was applied to
model choices as a function of attribute levels.
Results
95 eligible participants completed the survey; mean age was 62, 48% had recurrence,
and 17% were ever-PARP inhibitor users. Participants valued OS (average importance
weight 24.5 out of 100) and monthly costs (24.6) most highly, followed by risk of
death from MDS/AML (17.9), nausea (14.7), PFS (10.5) and fatigue (7.8). Participants
would accept 5% risk of MDS/AML if treatment provided 2.2 months additional OS or
4.8 months PFS. Participants would require gains of 2.6 months PFS to accept mild
treatment-related fatigue and 4.4 months to accept mild nausea.
Conclusions
When considering MT, women with ovarian cancer are most motivated by gains in OS.
Women expect at least 3–4 months of PFS benefit to bear mild side effects of treatment.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Impact on survival of 12 versus 3 monthly cycles of paclitaxel (175 mg/m2) administered to patients with advanced ovarian cancer who attained a complete response to primary platinum-paclitaxel: follow-up of a Southwest Oncology Group and Gynecologic Oncology Group phase 3 trial.Gynecol. Oncol. 2009; 114: 195-198
- Incorporation of bevacizumab in the primary treatment of ovarian cancer.N. Engl. J. Med. 2011; 365: 2473-2483
- A phase 3 trial of bevacizumab in ovarian cancer.N. Engl. J. Med. 2011; 365: 2484-2496
- Final overall survival of a randomized trial of Bevacizumab for primary treatment of ovarian cancer.J. Clin. Oncol. 2019; 37 (JCO1901009): 2317-2328
- OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer.J. Clin. Oncol. 2012; 30: 2039-2045
- Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase III trial.J. Clin. Oncol. 2014; 32: 1302-1308
- Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer.N. Engl. J. Med. 2016; 375: 2154-2164
- Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer.N. Engl. J. Med. 2018; 379: 2495-2505
- Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial.Lancet. 2017; 390: 1949-1961
- Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial.Lancet Oncol. 2017; 18: 1274-1284
- Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer.N. Engl. J. Med. 2012; 366: 1382-1392
- Maintenance poly (ADP-ribose) polymerase inhibitor therapy for ovarian cancer: precision oncology or one size fits all?.J. Clin. Oncol. 2017; 35: 3999-4002
- Niraparib in recurrent ovarian cancer.N. Engl. J. Med. 2017; 376: 801
- U.S. Food and Drug Administration-approved poly (ADP-ribose) polymerase inhibitor maintenance therapy for recurrent ovarian cancer: a cost-effectiveness analysis.Obstet. Gynecol. 2019; 133: 795-802
- Going for broke: a longitudinal study of patient-reported financial sacrifice in cancer care.J Oncol Pract. 2018; 14: e533-e546
- Clinical Practice Guidelines we Can Trust.National Academies Press, Washington, DC2011
- Delivering High-quality Cancer Care: Charting a New Course for a System in Crisis.National Academies Press, Washington, D.C2013
- Discrete choice experiments in health economics: past, present and future.Pharmacoeconomics. 2019; 37: 201-226
- Using conjoint analysis to elicit preferences for health care.BMJ. 2000; 320: 1530-1533
- Patient preferences for attributes of primary surgical debulking versus neoadjuvant chemotherapy for treatment of newly diagnosed ovarian cancer.Cancer. 2019; 125: 4399-4406
- Patient preferences in advanced or recurrent ovarian cancer.Cancer. 2014; 120: 3651-3659
- Preferences of women with epithelial ovarian cancer for aspects of genetic testing.Gynecol Oncol Res Pract. 2019; 6
- Endpoints in clinical trials: what do patients consider important? A survey of the Ovarian Cancer National Alliance.Gynecol. Oncol. 2016; 140: 193-198
- Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force.Value Health. 2013; 16: 3-13
- Marketing Research Methods in SAS.2010
- Statistical methods for the analysis of discrete choice experiments: a report of the ISPOR Conjoint Analysis Good Research Practices Task Force.Value Health. 2016; 19: 300-315
- Discrete Choice Models With Simulation.Cambridge University Press, 2009
- Mixed Logit with bounded distributions of correlated Partworths.in: AAaS R. Applications of Simulation Methods in Environmental and Resource Economics. Springer, Netherlands2005: 117-134
- A guide to measuring and interpreting attribute importance.Patient. 2019; 12: 287-295
- Eliciting benefit-risk preferences and probability-weighted utility using choice-format conjoint analysis.Med. Decis. Mak. 2011; 31: 469-480
- Incorporating patient-preference evidence into regulatory decision making.Surg. Endosc. 2015; 29: 2984-2993
- On approximating the statistical properties of elasticities.Rev. Econ. Stat. 1986; 68: 715-719
- Something is better than nothing: the value of active intervention in stated preferences for treatments to delay onset of Alzheimer’s disease symptoms.Value Health. 2019; 22: 1063-1069
- Ductal carcinoma in situ: to treat or not to treat, that is the question.Br. J. Cancer. 2019; 121: 285-292
- Niraparib in patients with newly diagnosed advanced ovarian cancer.N. Engl. J. Med. 2019; 381: 2391-2402
- Phase III PAOLA-1/ENGOT-ov25 Trial: Olaparib Plus Bevacizumab (Bev) as Maintenance Therapy in Patients (Pts) With Newly Diagnosed, Advanced Ovarian Cancer (OC) Treated with Platinum-based Chemotherapy (PCh) Plus Bev.(Presented at the) ESMO Congress, Barcelona, Spain2019 (September 28, 2019)
- Veliparib with first-line chemotherapy and as maintenance therapy in ovarian cancer.N. Engl. J. Med. 2019; 381: 2403-2415
- Expectation about maintenance therapy among the GINECO French ovarian cancer cohort from the European NOGGO/ENGOT-ov22 expression IV survey.Bull. Cancer. 2018; 105: 465-474
- Financial toxicity and implications for cancer care in the era of molecular and immune therapies.Ann Transl Med. 2018; 6: 166
- Prescription drug cost sharing: associations with medication and medical utilization and spending and health.JAMA. 2007; 298: 61-69
Article info
Publication history
Published online: January 22, 2020
Accepted:
January 15,
2020
Received in revised form:
January 14,
2020
Received:
December 17,
2019
Footnotes
☆This study was presented at the American Society of Clinical Oncology Annual Meeting, Chicago, IL, June 1, 2019.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
