Adding Enzalutamide to First-Line Treatment for Metastatic Hormone-Sensitive Prostate Cancer: A Cost-Effectiveness Analysis.

Peng-Fei Zhang,Dan Xie,Qiu Li

doi:10.3389/fpubh.2021.608375

Abstract

Background: The aim of this study is to evaluate the pharmacoeconomic profile of adding enzalutamide to first-line treatment for metastatic, hormone-sensitive prostate cancer (mHSPC) from the US and Chinese payers' perspectives.Materials and Methods: A Markov model with three health states: progression-free survival (PFS), progressive disease (PD), and death, was constructed. All patients were assumed to enter the model in the PFS state and transit according to the transition structure. Efficacy data were derived from the ENZAMET trial and Weibull distribution curves were modeled to fit the survival curves. Costs in the model included cost of drugs, best-supportive care (BSC), follow-up, tests, and adverse events (AEs)-related treatments. The primary endpoint of the study was incremental cost-effectiveness ratio (ICER). In addition, the impact of several key parameters on the results of the cost-effectiveness analysis was tested with one-way sensitivity analyses and probabilistic sensitivity analyses.Results: Overall, ICERs were $430,933.95/QALY and $225,444.74/QALY of addition of enzalutamide to androgen deprivation therapy (ADT) vs. ADT from the US and Chinese payers' perspective, respectively. The most influential factors were the utility for the PFS state and the cost of enzalutamide. At the willingness-to-pay (WTP) thresholds of $100,000.00/QALY in the US and $28,988.40/QALY in China, the probability of adding enzalutamide to first-line treatment being a cost-effective option for mHSPC was 0%.Conclusions: Based on the data from the ENZAMET trial and the current price of enzalutamide, adding enzalutamide to first-line treatment is not cost-effective for patients with mHSPC from the US and Chinse payers' perspectives.

Highlights

Prostate cancer is the second most frequently diagnosed cancer and ranks the fifth in cancer-related death in men worldwide
To investigate the cost-effectiveness of adding enzalutamide to first-line treatment for patients with metastatic hormonesensitive prostate cancer (mHSPC) compared to standard care, a Markov decision model, which included three health states [progression-free survival (PFS), progressive disease (PD) and death], was constructed
Over a lifetime horizon of 20 years, adding enzalutamide to first-line treatment gained an effectiveness of 6.21 QALYs at a cost of $1,396,827.63 from the US payers’ perspective, while from the Chinese payers’ perspective, the effectiveness and cost were 5.70 QALYs and $516,510.76

Summary

Introduction

Prostate cancer is the second most frequently diagnosed cancer and ranks the fifth in cancer-related death in men worldwide. Most patients with prostate cancer are diagnosed with localized disease, 10–20% of the patients are expected to be diagnosed with locally advanced or metastatic disease, for whom the standard first-line treatment is androgen deprivation therapy (ADT) [2]. The efficacy and safety of adding docetaxel or abiraterone to ADT, have been investigated in the first-line treatment for advanced/metastatic prostate cancer. All these drugs were demonstrated to significantly prolong the survivals in patients with metastatic hormonesensitive prostate cancer (mHSPC) [5,6,7,8]. The aim of this study is to evaluate the pharmacoeconomic profile of adding enzalutamide to first-line treatment for metastatic, hormone-sensitive prostate cancer (mHSPC) from the US and Chinese payers’ perspectives

Objectives

Methods

Results

Discussion

Conclusion