Abstract
BackgroundThe treatment of metastatic castration-resistant prostate cancer has changed with the introduction of radium-223, cabazitaxel, abiraterone and enzalutamide. To assess value for money, their cost effectiveness in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective was investigated.MethodsA cost-effectiveness analysis was conducted using efficacy, symptomatic skeletal-related event and safety data obtained from indirect treatment comparisons. Missing skeletal-related event data for cabazitaxel were conservatively assumed to be identical to radium-223. A Markov model combined these clinical inputs with Dutch-specific resource use and costs for metastatic castration-resistant prostate cancer treatment from a societal perspective. Total quality-adjusted life-years and costs in 2017 euros were calculated over a 5-year (lifetime) time horizon.ResultsRadium-223 resulted in €6092 and €4465 lower costs and 0.02 and 0.01 higher quality-adjusted life-years compared with abiraterone and cabazitaxel, respectively, demonstrating dominance of radium-223. Sensitivity analyses reveal a 64% (54%) chance of radium-223 being cost effective compared with abiraterone (cabazitaxel) at the informal €80,000 willingness-to-pay threshold. Compared with enzalutamide, radium-223 resulted in slightly lower quality-adjusted life-years (−0.06) and €7390 lower costs, revealing a 61% chance of radium-223 being cost effective compared with enzalutamide. The lower costs of radium-223 compared with abiraterone and enzalutamide are driven by lower drug costs and prevention of expensive skeletal-related events. Compared with cabazitaxel, the lower costs of radium-223 are driven by lower costs of the drug, administration and adverse events.ConclusionRadium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-017-0350-x) contains supplementary material, which is available to authorized users.
Highlights
Castration-resistant prostate cancer (CRPC) is an incurable form of prostate cancer resistant to surgical or pharmaceutical castration that occurs when the disease progresses despite castration levels of androgens
Radium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective
The aim of this study was to investigate the cost effectiveness of Ra-223 compared with CA, AA and EN, all in combination with the best standard of care, in patients with metastatic CRPC (mCRPC) previously treated with docetaxel from the Dutch societal perspective
Summary
Castration-resistant prostate cancer (CRPC) is an incurable form of prostate cancer resistant to surgical or pharmaceutical castration that occurs when the disease progresses despite castration levels of androgens It is termed metastatic CRPC (mCRPC) when the disease has developed (bone) metastases [1,2,3,4]. About 3800 patients per year are diagnosed with metastatic, hormonesensitive prostate cancer and despite hormonal therapy around 75% of these patients will progress to mCRPC, with the median time to progression ranging from 18 to 24 months [7]. These patients have a poor prognosis, and are expected to survive B19 months [8]. Presented at the European Cancer Congress on 27 September, 2015 in Vienna, Austria, at the International Society For Pharmacoeconomics and Outcomes Research 18th Annual European Congress on the 9 November, 2015 in Milan, Italy, and at the Nederlandse Vereniging voor Nucleaire Geneeskunde Meeting on the 20 May, 2016 in Eindhoven, The Netherlands.
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