Cost‐effectiveness analysis of degarelix for advanced hormone‐dependent prostate cancer

Abstract

What ' s known on the subject? and What does the study add? The European Medicines Evaluation Agency recognised that the principal advantage of degarelix is the avoidance of the transient rise in testosterone. This paper compares the cost-effectiveness of degarelix with the most common treatment in the UK (LHRHa plus short-term anti-androgen) for the management of prostate cancer, focusing on the costs and clinical consequences that might be associated by the avoidance of the transient rise in testosterone. Our analysis suggests that, at the current UK list price, degarelix would not represent good value for money for the NHS.

A cost–utility analysis of degarelix in the treatment of advanced hormone-dependent prostate cancer in the United Kingdom

“…As spinal cord compression is a rare event, data were not available from the trial. Events were incorporated in the same manner as in Lu et al 17 , which used a decision tree to estimate the proportion of patients experiencing mild and severe spinal cord compression as a result of the testosterone flare associated with LHRH agonist treatment. Patients have a risk of suffering from spinal cord compression in the first cycle of the model and those who experience it are treated with rescue therapies.…”

“…Consultation with Welsh physicians indicated that rescue therapy would consist of surgery (5% of patients) or radiotherapy (95% of patients). The outcomes of treatment are then modeled (no lasting complications, improvement or paraplegia), with the proportion of patients experiencing each outcome taken from Lu et al 17 .…”

“…Four analyses evaluating the cost-effectiveness of degarelix compared to LHRH agonists have previously been published: a manuscript published in 2012 comparing degarelix with triptorelin for patients with metastatic prostate cancer based solely upon the differences between degarelix and LHRH agonists in terms of the clinical outcomes of testosterone flare, a US analysis of costeffectiveness based upon the effects of PSA progression (recurrence) on movement through lines of treatment therapy and two posters presented at the International Society For Pharmacoeconomics and Outcomes Research meetings detailing cost-effectiveness analyses submitted to the Scottish Medicines Consortium and All Wales Medicines Strategy Group (AWMSG) [17][18][19][20] . Degarelix was approved for use in both Scotland and Wales with the application of a patient access scheme (PAS) following publication of the manuscript by Lu et al 17 , meaning that the analyses used within the submissions were not available to Lu et al at the time of writing 21,22 .…”

“…Degarelix was approved for use in both Scotland and Wales with the application of a patient access scheme (PAS) following publication of the manuscript by Lu et al 17 , meaning that the analyses used within the submissions were not available to Lu et al at the time of writing 21,22 .…”

Gonadotropin-releasing hormone antagonist: A real advantage?

“…However, the number of patients in that stage may be considerably lower in recent years because many patients are diagnosed and treated earlier in the course of their disease. The rate of spinal cord compression, the most serious adverse event, was estimated to be low (o1%) in the study by Lu et al [18], although admittedly, the true incidence is unknown.…”