Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer

Abstract

BackgroundThe treatment of metastatic castration-resistant prostate cancer has changed with the introduction of radium-223, cabazitaxel, abiraterone and enzalutamide. To assess value for money, their cost effectiveness in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective was investigated.MethodsA cost-effectiveness analysis was conducted using efficacy, symptomatic skeletal-related event and safety data obtained from indirect treatment comparisons. Missing skeletal-related event data for cabazitaxel were conservatively assumed to be identical to radium-223. A Markov model combined these clinical inputs with Dutch-specific resource use and costs for metastatic castration-resistant prostate cancer treatment from a societal perspective. Total quality-adjusted life-years and costs in 2017 euros were calculated over a 5-year (lifetime) time horizon.ResultsRadium-223 resulted in €6092 and €4465 lower costs and 0.02 and 0.01 higher quality-adjusted life-years compared with abiraterone and cabazitaxel, respectively, demonstrating dominance of radium-223. Sensitivity analyses reveal a 64% (54%) chance of radium-223 being cost effective compared with abiraterone (cabazitaxel) at the informal €80,000 willingness-to-pay threshold. Compared with enzalutamide, radium-223 resulted in slightly lower quality-adjusted life-years (−0.06) and €7390 lower costs, revealing a 61% chance of radium-223 being cost effective compared with enzalutamide. The lower costs of radium-223 compared with abiraterone and enzalutamide are driven by lower drug costs and prevention of expensive skeletal-related events. Compared with cabazitaxel, the lower costs of radium-223 are driven by lower costs of the drug, administration and adverse events.ConclusionRadium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-017-0350-x) contains supplementary material, which is available to authorized users.

Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

“…The reviewed studies fulfilled 83.3% [22] and 87.5% [23,24] of CHEERS statement checklist. The studies generally represented a good quality.…”

“…A study by Peters et al [23] showed that cabazitaxel dominated abiraterone acetate, whereas studies by Wilson L. et al and Zhong L. et al revealed cabazitaxel as costlier and more effective than abiraterone acetate. Moreover, the ICER values of $337,983.33 /QALY and $918,166.67/QALY were far above the costeffectiveness threshold of the US.…”

“…The studies by Peters ML.et al [23] and Wilson L.et al [22] showed that cabazitaxel was costlier and more effective than enzalutamide. The ICER (€41785.71) was below the informal costeffectiveness threshold of the Netherlands (€80,000).…”

“…The follow-up period of the reviewed articles was 18 months [22,24] and 5 years [23]. All the three studies did not recommend cabazitaxel for the treatment of docetaxel-refractory mCRPC.…”

“…All the three studies did not recommend cabazitaxel for the treatment of docetaxel-refractory mCRPC. Two of the studies [22,24] suggested abiraterone as a treatment, whereas a study by Peters ML.et al [23] recommended radium-223 as a costeffective option for docetaxel-refractory mCRPC patients.…”