Health economic evaluation of Mirvetuximab soravtansine for the treatment of FRα-positive, platinum resistant ovarian cancer in Germany

PURPOSE: Mirvetuximab soravtansine (MIRV) is an antibody-drug conjugate targeting the folate receptor α (FRα), approved for FRα-positive platinum-resistant ovarian cancer based on improved progression-free and overall survival and higher response rates compared with standard therapy in the MIRASOL trial. The aim of the present study was to provide a health economic evaluation of MIRV from the perspective of the statutory health insurance in Germany. METHODS AND FINDINGS: A Markov state-transition model with three health states (stable, progressive, dead) was used with a time horizon of fives years. Transition probabilities were derived from published Kaplan-Meier survival curves of the MIRASOL trial. Direct costs and literature-based utilities were applied. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses addressed the uncertainty of the model. In the base case, MIRV resulted in an incremental gain of 0.408 life years (LYs) or 0.226 quality-adjusted life years (QALYs) compared to standard therapy. Incremental costs of €128,338.84 were incurred. This resulted in an ICER of €314,753.36 per additional LYs and €567,734.77 per QALY. All analyzed scenarios exceeded the defined threshold, of three times the German gross domestic product per capita, with the drug price having the greatest influence. CONCLUSION: MIRV is highly likely to be a more effective treatment option than the chemotherapies currently available for patients with FRα-positive, platinum-resistant ovarian cancer, as approximately 75-90% of ovarian cancers are FRα-positive. However, in the current circumstances, MIRV is unlikely to be considered cost-effective within the German healthcare context without reduction in the drug price.