Abstract
ABSTRACTObjective To assess the cost-effectiveness of chemohormonal therapy in patients with metastatic hormone-sensitive and non-metastatic high-risk prostate cancer.Methods An analytical decision model was developed to determine the cost-effectiveness of chemohormonal therapy versus androgen deprivation therapy alone in patients with metastatic hormone-sensitive prostate cancer and patients with non-metastatic high-risk prostate cancer. The cost-effectiveness in metastatic patients with a high-volume disease was assessed separately. The model used data from randomized clinical trials and drug acquisition costs in Brazil. In addition, the costs of post-progression therapies have been included in this model. The benefits to health are expressed as the quality-adjusted life-years, and the incremental cost-effectiveness ratios were calculated.Results Chemohormonal therapy may be associated with improved quality-adjusted life-years for all patient. The improvement was more than six times greater for patients with high-volume metastatic disease. In these patients, the incremental cost-effectiveness ratios were up to 74% lower than the incremental cost-effectiveness ratios of patients with non-metastatic disease.Conclusion Chemohormonal therapy has been more cost-effective in patients with high-volume metastatic disease.
Highlights
Prostate cancer is the second most common neoplasm in men worldwide with an estimated 1,100,000 new cases and 307,000 deaths reported in 2012.(1) In Brazil, between 2016 and 2017, the Instituto Nacional de Cancer José Alencar Gomes da Silva (INCA) estimates that prostate cancer will be the most common neoplasm among men, excluding non-melanoma skin cancers.[2]U.S data indicate that of all prostate cancer cases, 80% are confined to the prostate gland, 12% are locally advanced and invaded regional lymph nodes, and 4% are distant metastases; approximately 4% of the cases have an unknown stage.[3]
U.S data indicate that of all prostate cancer cases, 80% are confined to the prostate gland, 12% are locally advanced and invaded regional lymph nodes, and 4% are distant metastases; approximately 4% of the cases have an unknown stage.[3] the lack of data in Brazil, it is hypothesized that there will be a greater proportion of metastatic disease reported at diagnosis due to socioeconomic reasons.[4]
The GETUG-AFU 15 study (Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer) did not show any improvement in overall survival (OS) following treatment with androgen deprivation therapy (ADT) plus docetaxel versus ADT alone; an objective response rate of 28% was achieved in patients who were treated with a combination of ADT and docetaxel.[6]. The median progression free survival (PFS) for the ADT plus docetaxel group increased to 23.4 months from 18.5 months for the ADT group.[6]
Summary
Prostate cancer is the second most common neoplasm in men worldwide with an estimated 1,100,000 new cases and 307,000 deaths reported in 2012.(1) In Brazil, between 2016 and 2017, the Instituto Nacional de Cancer José Alencar Gomes da Silva (INCA) estimates that prostate cancer will be the most common neoplasm among men, excluding non-melanoma skin cancers.[2]U.S data indicate that of all prostate cancer cases, 80% are confined to the prostate gland, 12% are locally advanced and invaded regional lymph nodes, and 4% are distant metastases; approximately 4% of the cases have an unknown stage.[3]. The GETUG-AFU 15 study (Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer) did not show any improvement in OS following treatment with ADT plus docetaxel versus ADT alone; an objective response rate of 28% was achieved in patients who were treated with a combination of ADT and docetaxel.[6] The median progression free survival (PFS) for the ADT plus docetaxel group increased to 23.4 months from 18.5 months for the ADT group (hazard ratio - HR: 0.75, 95% of confidence interval - 95%CI: 0.59-0.94; p=0.015).(6). The Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) and GETUG-AFU 12 studies have assessed chemotherapy plus ADT for non-metastatic patients with a high-risk of localized disease (e.g. elevated prostate specific antigen − PSA at diagnosis and highgrade tumors). This is the life-years provided by the treatment adjusted to the quality of life score ( known as utility, on a scale of zero, dead, to 1, full capacity).(10)
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