Cost-effectiveness Analysis of Innovative Therapy for Patients with Newly Diagnosed Hormone-Sensitive Metastatic Prostate Cancer |
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| Institution: | 1. Department of Pharmacy, University Hospital of Besançon, Besançon, France;2. Department of Medical Oncology, European Hospital Georges Pompidou, University of Paris, Paris, France;3. Medical Oncology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, Marseille, France;4. Department of Urology, University Hospital of Besançon, Besançon, France;5. Curie Institute, Paris, France;6. Department of Medical Oncology, Hospital Saint-Louis, APHP, Paris, France;7. Department of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States;8. Department of Medical Oncology, Cancérologie de Lorraine Institute, Nancy, France;9. Department of Medical Oncology, University Hospital of Besançon, Besançon, France;10. INSERM UMR 1098, University of Bourgogne-Franche-Comté, Besançon, France;1. Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA;2. Urology Section, Durham VA Medical Center, Durham, NC;3. Analysis Group, Inc., Montréal, QC, Canada;4. Analysis Group, Inc., Boston, MA;5. Janssen Scientific Affairs LLC, Titusville, NJ;6. White River Junction VA Medical Center, White River Junction, VT;7. Dartmouth Geisel School of Medicine, Hanover, NH |
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| Abstract: | BackgroundThe optimal therapeutic strategies for patients with metastatic hormone-sensitive prostate cancer (mHSPC) followed by metastatic castrate-resistant prostate cancer (mCRPC), in terms of cost and effectiveness, remains unknown. This study aims to compare the cost-effectiveness of various potential strategies, from the start of first-line treatment in mHSPC to the death of the patients.MethodsTwo Markov decision-analysis models were developed, one for cohort A “asymptomatic/mildly symptomatic patients in mCRPC”, and one for cohort B “symptomatic patients in mCRPC”. Each strategy reflects daily practice for mHSPC until progression in mCRPC from the start of first treatment regimen with either docetaxel or abiraterone acetate plus prednisone (AA) in mHSPC to the death of the patient. The cost-effectiveness analysis was performed from the French public health care system perspective. Only direct medical costs were included. Survival data were extracted from results of published randomized clinical trials.ResultsFor cohort A, docetaxel followed by AA is the most cost-effective therapeutic strategy (€96,925 for 4.24 life-years). For cohort B, docetaxel followed by docetaxel is the most cost-effective therapeutic strategy (€81,463 for 4.05 life-years). Sensitivity analyses confirmed the robustness of our results except for a price reduction of 70% for AA or enzalutamide.ConclusionOur approach is innovative to the extent that our analysis considers various potential strategies for metastatic prostate cancer (mPC). Our economic evaluation suggests that a price reduction of AA or enzalutamide impacts on the results. This approach must continue, including new drugs for patients with mPC. |
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