Abstract
BackgroundTreatment of metastatic prostate cancer is associated with high personal and economic burden. Recently, new treatment options for castration-resistant prostate cancer became available with promising survival advantages. However, cost-effectiveness of those new treatment options is sometimes ambiguous or given only under certain circumstances. The aim of this study was to systematically review studies on the cost-effectiveness of treatments and costs of castration-resistant prostate cancer (CRPC) and metastasizing castration-resistant prostate cancer (mCRPC) on their methodological quality and the risk of bias.MethodsA systematic literature search was performed in the databases PubMed, CINAHL Complete, the Cochrane Library and Web of Science Core Collection for costs-effectiveness analyses, model-based economic evaluations, cost-of-illness analyses and budget impact analyses. Reported costs were inflated to 2015 US$ purchasing power parities. Quality assessment and risk of bias assessment was performed using the Consolidated Health Economic Evaluation Reporting Standards checklist and the Bias in Economic Evaluations checklist, respectively.ResultsIn total, 38 articles were identified by the systematic literature search. The methodological quality of the included studies varied widely, and there was considerable risk of bias. The cost-effectiveness treatments for CRPC and mCRPC was assessed with incremental cost-effectiveness ratios ranging from dominance for mitoxantrone to $562,328 per quality-adjusted life year gained for sipuleucel-T compared with prednisone alone. Annual costs for the treatment of castration-resistant prostate cancer ranged from $3,067 to $77,725.ConclusionThe cost-effectiveness of treatments of CRPC strongly depended on the willingness to pay per quality-adjusted life year gained/life-year saved throughout all included costs-effectiveness analyses and model-based economic evaluations. High-quality cost-effectiveness analyses based on randomized controlled trials are needed in order to make informed decisions on the management of castration-resistant prostate cancer and the resulting financial impact on the healthcare system.
Highlights
Among men, prostate cancer is the most commonly diagnosed cancer in developed countries and the second most commonly diagnosed cancer worldwide
A systematic literature search was performed in the databases PubMed, CINAHL Complete, the Cochrane Library and Web of Science Core Collection for costs-effectiveness analyses, model-based economic evaluations, cost-of-illness analyses and budget impact analyses
The cost-effectiveness treatments for castration-resistant prostate cancer (CRPC) and metastasizing castration-resistant prostate cancer (mCRPC) was assessed with incremental costeffectiveness ratios ranging from dominance for mitoxantrone to $562,328 per qualityadjusted life year gained for sipuleucel-T compared with prednisone alone
Summary
Prostate cancer is the most commonly diagnosed cancer in developed countries and the second most commonly diagnosed cancer worldwide. In 2015, approximately 1.6 million new prostate cancer cases occurred worldwide [1]. Prostate cancer was associated with incidence rates of 70 and 15 per 100,000 population and mortality rates of 10 and 7 per 100,000 population in developed countries and developing countries in 2012, respectively [1]. In the European Union, prostate cancer has been associated with high total economic costs (€8.4 billion) in 2009, consisting of healthcare costs (€5.4 billion) including medication costs (€3.1 billion), informal care costs (€1.9 billion) and costs due to productivity losses attributable to mortality (€0.7 billion) [2]. Treatment of metastatic prostate cancer is associated with high personal and economic burden. New treatment options for castration-resistant prostate cancer became available with promising survival advantages. The aim of this study was to systematically review studies on the cost-effectiveness of treatments and costs of castration-resistant prostate cancer (CRPC) and metastasizing castration-resistant prostate cancer (mCRPC) on their methodological quality and the risk of bias.
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