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Cost-Effectiveness of Systemic Treatments for Metastatic Castration-Sensitive Prostate Cancer
Study identifies the most cost-effective systemic treatments for metastatic castration-sensitive prostate cancer (Value Health. 2021. doi:10.1016/j.jval.2021.10.016).
“Several chemohormonal drugs are approved and recommended as add-on therapies to androgen deprivation therapy (ADT) for metastatic castration-sensitive prostate cancer, with distinct mechanisms of action, different efficacy and safety profile, and widely varying costs,” explained Lin Wang, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, and colleagues.
This study aimed to assess the cost-effectiveness of these systemic treatments from a US health care sector perspective with a lifetime horizon.
Researchers built a partitioned survival model to predict health trajectories by treatment. The model was based on a network meta-analysis of 7 clinical trials and included 7287 patients aged 36 to 94 years between 2004 and 2018. The treatment regimens assessed were ADT alone, docetaxel with ADT, abiraterone acetate with ADT, enzalutamide with ADT, and apalutamide with ADT.
Probabilistic sensitivity analyses tested for parameter uncertainties. Drug acquisition costs were derived using the Federal Supply Schedule and adopted generic drug prices when available. Cost-effectiveness of treatments were measured using incremental cost-effectiveness ratio (ICER).
Mean costs were approximately $392,000 with ADT alone; $415,000 with docetaxel plus ADT; $464,000 with abiraterone acetate plus ADT, $597,000 with enzalutamide plus ADT, and $959,000 with apalutamide plus ADT. Mean quality adjusted life years (QALYs) were 3.38, 3.92, 4.76, 3.92, and 5.01, respectively.
Added to ADT, docetaxel had an ICER of $42,069 per QALY over ADT alone; abiraterone acetate had an ICER of $58,814 per QALY over docetaxel; apalutamide had an ICER of $1,979,676 per QALY over abiraterone acetate; and enzalutamide was dominated.
At a willingness to pay (WTP) threshold below $50,000 per QALY, the most cost-effective treatment is docetaxel plus ADT. At a WTP between $50,000 and $200,000 per QALY, the most cost-effective treatment option is abiraterone acetate plus ADT.
“These findings underscore the value of abiraterone acetate plus ADT given its relative cost-effectiveness to other systemic treatments for metastatic castration-sensitive prostate cancer,” concluded Dr Wang and colleagues.
