Abstract
PurposeTo perform a cost-effectiveness analysis of radium-223 plus Best Supportive Care (BSC) compared to BSC in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) and without previous docetaxel treatment in Spain.Design and methodsA Markov model was developed to compare radium-223 versus BSC and to accrue the health outcomes and costs of a simulated cohort of mCRPC patients. Quality-adjusted life year (QALY) and life year (LY) were selected as health outcomes to measure the effectiveness of treatment alternatives. Main health resource use and efficacy inputs were obtained from a randomized controlled trial comparing radium-223 versus placebo. Unit costs were retrieved from Spanish databases and published sources. One-way and probabilistic sensitivity analyses were carried out to assess uncertainty.ResultsTotal costs and QALYs were €65 067 and 1.12 QALYs for radium-223 and €55 437 and 0.77 QALYs for BSC. Therefore, incremental costs per QALY were €27 606. The sensitivity analysis showed that with a willingness-to-pay threshold of €30 000 per QALY, radium-223 would have a probability of 48% of being cost-effective compared to BSC.ConclusionsAlthough results must be assessed with caution, from the Spanish National Health System perspective and based on the results of the present analysis, radium-223 could be a suitable option of health resources’ utilization for end of life mCRPC without previous docetaxel treatment, subject to a moderate level of uncertainty.
Highlights
Prostate cancer is the second most common cancer among men, after skin cancer[1] and the fifth-leading cause of death, accounting for 6.6% of all cancer deaths, worldwide
The sensitivity analysis showed that with a willingness-to-pay threshold of €30 000 per Quality-adjusted life year (QALY), radium-223 would have a probability of 48% of being cost-effective compared to Best Supportive Care (BSC)
Conclusions: results must be assessed with caution, from the Spanish National Health System perspective and based on the results of the present analysis, radium-223 could be a suitable option of health resources’ utilization for end of life metastatic castration-resistant prostate cancer (mCRPC) without previous docetaxel treatment, subject to a moderate level of uncertainty
Summary
Prostate cancer is the second most common cancer among men, after skin cancer[1] and the fifth-leading cause of death, accounting for 6.6% of all cancer deaths, worldwide. Mortality is higher in developing countries, doing special mention to the black populations.[2] the lowest mortality rate belongs to the Asian population.[1]. In Spain, prostate cancer is the most frequently diagnosed cancer in men and the second one when both sexes are considered. In 2010 there was an incidence of 27 853 new cases of prostate cancer, representing 12.9% of all diagnosed tumors. Prostate cancer is the third leading cause of death, which corresponds to 8.6% of the total deaths caused by cancer.[3]
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