Cost-effectiveness analysis of treatments for metastatic castration resistant prostate cancer

Abstract

ObjectiveTreatment options for metastatic castration resistant prostate cancer (mCRPC) have expanded rapidly in recent years. Given the significant economic burden, we sought perform a cost-effectiveness analysis (CEA) of the contemporary treatment paradigm for mCRPC.MethodsWe devised a treatment protocol consisting of sipuleucel-T, enzalutamide, abiraterone, docetaxel, radium-223, and cabazitaxel. We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials. We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA. Our analysis assumed US$100,000 per life year saved (LYS) as the threshold societal willingness to pay.ResultsIncremental cost-effectiveness ratios (ICER) for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingness-to-pay of US$100,000 per LYS, the lowest of which was sipuleucel-T + enzalutamide + abiraterone + docetaxel at US$207,714 per LYS. Enzalutamide + abiraterone + docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.ConclusionBased on the available survival data and current costs of treatment, all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS. Improvements in this regard can only come with a reduction in pricing, better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.

The prognosis of different distant metastases pattern in prostate cancer: A population based retrospective study

“…Despite improvement in surgery, radiotherapy, chemotherapy, and endocrinetherapy, most deaths of patients with prostate cancer (PCa) occurred due to distant metastasis. The bone and lymph node metastases have been recognized the most typical metastatic pattern of extraprostatic tumor spread . Nevertheless, several studies reported that up to 15% of patients with PCa might be affected by atypical metastases at diagnosis, including brain, liver, and lung metastases, etc .…”

Cost considerations for systemic therapy for patients with advanced genitourinary malignancies

“…Those authors also estimated that 10 cycles of cabazitaxel would cost $46,180 . Another review estimated that the costs for 9.5 cycles of docetaxel or 6 cycles of cabazitaxel were $16,235 and $50,039, respectively …”

“…Their cost‐utility model revealed that docetaxel was associated with an incremental cost‐effectiveness ratio (ICER) of £32,706 ($51,028) per QALY gained compared with mitoxantrone. A more recent analysis of Medicare reimbursements for elderly men with metastatic prostate cancer indicated that those who received chemotherapy (either docetaxel or mitoxantrone) had an ICER of $99,146 per life‐year gained compared with those who did not receive chemotherapy (Table ) …”

“…Wilson et al estimated that the drug costs associated with abiraterone use would be $47,577, factoring in laboratory monitoring and clinic visits . For enzalutamide, estimated costs were higher, ranging from $61,835 to $62,266 per regimen …”

“…On the basis of an analysis evaluating systemic therapy among patients with CRPC who were chemotherapy‐naive, receipt of sipuleucel‐T was associated with an ICER of $207,714 per life‐year compared with the standard of care (Table ) . For the model without sipuleucel‐T, the receipt of enzalutamide in a chemotherapy‐naive population was associated with an ICER of $220,594 per QALY.…”