Objectives: Enzalutamide prolonged overall survival and radiographic progression-free survival (rPFS), delayed initiation of cytotoxic chemotherapy and maintained quality of life in patients with chemotherapy-naïve mCRPC after failure of ADT (PREVAIL; Beer et al 2014). The cost-effectiveness of enzalutamide, compared with abiraterone plus prednisone (ABI+P) for patients with chemotherapy-naïve mCRPC, was evaluated from the perspective of the Canadian Ministries of Health (MoH). MethOds: A Markov model was developed to capture time spent by patients in various health states: stable, progression and death. Results were reported as incremental costs per additional quality-adjusted life year (QALY) gained over a 10-year period. Transition probabilities were derived from patient-level data from PREVAIL and a network meta-analysis (NMA) of available trials. Base case analysis focused on direct medical costs from the Canadian MoH perspective. Cost data was obtained from a variety of Canadian sources, valued in 2015 Canadian dollars. A 5% discount rate was applied to costs and outcomes. Multiple sensitivity analyses were performed. Results: NMA results suggested no difference between enzalutamide and ABI+P for overall survival, but indicated that enzalutamide is superior to ABI+P for rPFS (hazard ratio 0.35; credible interval 0.27, 046). The improvement in rPFS translated into a longer mean duration of stable disease with enzalutamide (36.7 months) than with ABI+P (16.4 months), and greater total QALYs (enzalutamide 2.65; ABI+P 2.23). From the Canadian MoH perspective, enzalutamide had an incremental cost-effectiveness ratio (ICER) of $92,690 per additional QALY gained versus ABI+P. The ICER was robust over a wide range of sensitivity analyses. In the probabilistic sensitivity analysis, the mean ICER was $110,036 per QALY gained versus ABI+P, with > 60% of iterations falling below a willingness-to-pay threshold of $100,000 per QALY gained. cOnclusiOns: Enzalutamide is considered a costeffective treatment option compared to ABI+P in patients with chemotherapy-naïve mCRPC after failure of ADT. PCN249 EAstErN CooPErAtivE oNCology groUP (ECog) PErformANCE stAtUs (Ps) is AN iNdEPENdENt PrEdiCtor of hrqol iN UNrEsECtAblE or mEtAstAtiC mElANomAObjectives: In analysis of health state utilities derived from a nivolumab phase III clinical trial a statistically significant difference in baseline utilities was noted between nivolumab (NIVO) and dacarbazine (DTIC) treatment arms. The aim of this study was to analyse and assess possible drivers of this difference in mean baseline utility. MethOds: Patient demographics and baseline disease characteristics were compared between treatment arms to identify any variables which may be responsible for the observed differences in baseline utilities. All identified variables were included in a generalised linear model and tested for significance differences in a stepwise manner to determine the final predictive utility model. Results: Population demographics and baseline disease characteristic...
A89treatment was based on stage and prognostic score. Other model inputs were literature-derived or assumption-based. Costs and QALYs were discounted at a 3% annual rate. One-way and probabilistic sensitivity analyses examined the relative impact of model inputs. Results: In the base case scenario 44% of patients received ACT using the prognostic test vs. 38% based on SoC. Total costs were $131,287 and $125,594 and total QALYs gained were 5.33 and 5.16 for the prognostic test and SoC, respectively. The incremental cost-effectiveness ratio (ICER) for the prognostic test was $34,055/QALY gained. One-way sensitivity analyses indicated the probability of receiving ACT for high-risk, stage Ib patients and the ACT treatment benefit were the largest drivers of cost-effectiveness. The probabilistic sensitivity analysis ICER was $44,196/QALY gained. The prognostic test was costeffective in 51.1% of the simulations at a willingness-to-pay threshold of $50,000/ QALY gained. ConClusions: The results of this study suggest that using myPlan Lung Cancer to guide ACT decisions is cost-effective compared to a SoC approach according to globally accepted thresholds. PCN124 EstimatioN of thE Quality adjustEd ProgrEssioN frEE survival of thE trEatmENt arms of thE BolEro-2 trial
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