Comparative clinical effects and cost–effectiveness of maximum androgen blockade, docetaxel with androgen deprivation therapy and ADT alone for the treatment of mHSPC in China

Abstract

Aim: To compare the clinical effects and cost–effectiveness of maximum androgen blockade (MAB), docetaxel to androgen deprivation therapy (Doc-ADT) and ADT alone for the treatment of patients with metastatic hormone-sensitive prostate cancer in China. Methods: A network meta-analysis and a Markov model were adopted for effectiveness and economic evaluation. Results: The hazard ratios of overall survival and progression-free survival were 0.782 and 0.628 for Doc-ADT versus ADT alone; 0.897 and 0.824 for MAB versus ADT alone. Doc-ADT was cost-effective compared with MAB and ADT alone, with an incremental cost–effectiveness ratio of CNY 96,848 and CNY 67,758 per quality-adjusted life year, respectively. MAB was cost-effective compared with ADT alone, with an incremental cost–effectiveness ratio of CNY 137,487 per quality-adjusted life year. Conclusion: Doc-ADT is likely the optimal option from the perspective of both clinical outcomes and economic considerations.

Survival modelling and cost-effectiveness analysis of treatments for newly diagnosed metastatic hormone-sensitive prostate cancer

“…Our finding of ADT+docetaxel being cost-effective versus ADT is also consistent with previous CEAs which compared either fewer strategies simultaneously or based on earlier data, and from the perspectives of North America [ 32 , 39 , 40 ], China [ 41 – 43 ], Hong Kong [ 44 ], the UK [ 45 ], and France [ 46 ]. Compared with ADT monotherapy only and from a Canadian perspective, ADT+apalutamide treatment was unlikely to be cost-effective versus ADT [ 47 ].…”

Balancing efficacy and financial toxicity in the management of metastatic castration-sensitive prostate cancer

“…The investigators concluded that the addition of docetaxel to ADT in high-volume mCSPC was an economically attractive approach. Of note, similar and consistent findings have been reported by other studies from Brazil, the U.K., China, and the U.S. [5][6][7][8] This is likely due to the fact that docetaxel is a generic chemotherapy drug, is administered for a limited number of six cycles (18 weeks), and only has a short-term impact on quality of life. However, the benefit in low-volume mCSPC remains controversial and many patients and physicians would prefer to avoid chemotherapy if possible.…”