Abstract
ABSTRACTObjective To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation.Methods We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects.Results Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively.Conclusion The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.
Highlights
Prostate cancer is the most common neoplasm among men in Brazil, excluding non-melanoma skin cancers.[1]Androgen deprivation therapy (ADT) used to be the standard treatment for newly diagnosed metastatic prostate cancer, known as hormone-sensitive metastatic prostate cancer
STAMPEDE assigned 2,962 men and found an overall survival (OS) benefit with the addition of docetaxel to ADT compared with ADT alone.[2,3] Median OS seems to be higher in STAMPEDE compared with CHAARTED because men with high-risk localized prostate cancer were eligible to STAMPEDE.[2,3]
The utility values of each health state were extracted from literature.[9]. Failure-free survival (FFS) and OS of each arm in the model were extracted from the area under curve available in STAMPEDE clinical trials.[3,4] The comparison between ADT plus abiraterone and ADT plus docetaxel used the outcomes retrieved from our recently published network meta-analysis.[10]. A lifetime horizon of 7 years was considered for FFS and OS using an exponential estimate (Figure 2A and 2B)
Summary
Prostate cancer is the most common neoplasm among men in Brazil, excluding non-melanoma skin cancers.[1]Androgen deprivation therapy (ADT) used to be the standard treatment for newly diagnosed metastatic prostate cancer, known as hormone-sensitive metastatic prostate cancer. In 2017, two other studies evaluated the combination of abiraterone plus ADT versus ADT alone for castrationsensitive metastatic prostate cancer.[4,5] STAMPEDEABI randomized 1,917 patients and revealed that combinatory treatment improved OS by 37% when compared to ADT alone.[4] LATITUDE enrolled 1,199 men and showed that abiraterone plus ADT improved 3-year survival rate by 17%, as compared to ADT alone.[5]. Abiraterone is a steroidal CYP17A1 inhibitor that inhibits androgen synthesis in adrenal glands This mechanism of action is interesting because adrenal gland is the second most important androgen-secreting gland (after testes) and is responsible for androgen secretion among men castrated by ADT. CHAARTED, STAMPEDE and LATITUDE changed the mindset on prostate cancer treatment with their results, creating two additional standard therapies (docetaxel plus ADT, and abiraterone plus ADT) for hormone-sensitive metastatic prostate cancer. Due to the lack of data comparing abiraterone plus ADT versus docetaxel plus ADT, only indirect comparisons are possible
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