Cost-Effectiveness Analysis of Abiraterone Acetate Treatment Compared with Cabacitaxel in the Republic of Panama, in Patients with Metastatic Castration-Resistant Prostate Cancer that Have Failed to Chemotherapy with Docetaxel

Abstract

Objectives: To estimate the cost-effectiveness of nab-paclitaxel+gemcitabine (Npg) versus gemcitabine (Gem) alone for the first-line treatment of metastatic pancreatic cancer in Greece from a National Health System perspective MethOds: A Markov model was developed, included several stages such as: "pre-progression on firstline treatment", "pre-progression off first-line treatment", "post progression", "four weeks to death" and "death". Data from the MPACT trial were used to estimate overall survival (Life-Years-(LYs)) and adverse events. The prices of drugs used in the model are publicly available for all hospitals in Greece. Cost assigned in each health state reflected: drugs, adverse events, monitoring, administration and palliative care. Utility values were obtained from the international literature to estimate Quality-Adjusted-Life-Years (QALYs). Costs and health gains were discounted at 3.5% per annum. A probabilistic sensitivity analysis was also conducted to construct confidence intervals (CI). Results: The mean number of QALYs was 0.71 (95%CI: 0.66-0.78) and 0.56 (95%CI: 0.52-0.60) for Npg and Gem, respectively, giving an incremental gain of 0.15 (95%CI: 0.08-0.25) QALYs in favour of Npg. The mean cost of therapy per patient was estimated at € 15,628 (95%CI: € 14,377-€ 17,027) and € 8,284 (95%CI: € 7,455-€ 9,112) for Npg and Gem, respectively. The incremental cost per LY gained with Npg was estimated at € 37,007 and the incremental cost per QALY gained at € 47,120. The probability for Npg to be cost-effective at a threshold three times the per capita income (€ 60,000 per QALY) was 82%. cOnclusiOns: The severity of pancreatic cancer, in combination with the limited number of effective treatments, results in a high level of unmet need. If the societal willingness-to-pay threshold for an additional QALY is relatively higher for patients with short life expectancy or for diseases with a relatively higher burden, the combination of nab-paclitaxel+gemcitabine could be considered a cost-effective choice compared with gemcitabine alone in Greece.

Uso de acetato de abiraterona en pacientes con cáncer de próstata metastásico resistente a la castración, vírgenes a quimioterapia. Experiencia de la vida real en un Centro Médico de la Ciudad de México

“…(6) El acetato de abiraterona proporciona (7)(8)(9) A pesar de las expectativas, la experiencia clínica con acetato de abiraterona en Latinoamérica es escasa. Algunos estudios en países latinoamericanos sugieren un costo-beneficio efectivo como terapia oncológica, y con menos efectos secundarios; (10,11) mientras que otros estudios plantean controversias en sus beneficios. (12,13) En la población mexicana no hay informes previos con respecto a los beneficios terapéuticos o evidencias de su uso en el mundo real.…”