PCN19 Effectiveness and Medical Costs of Abiraterone Acetate Versus Docetaxel in First-LINE Treatment of Metastatic Castration-Resistant Prostate Cancer from the French Nationwide Claims Database (SNDS): Camerra Study

Abstract

To compare the effectiveness and medical costs of abiraterone acetate versus docetaxel as first-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) in real-life setting. All mCRPC patients initiating abiraterone acetate or docetaxel as first-line treatment in 2014 were identified and followed for 3 years in the SNDS main scheme (86% of the French Nationwide claims database). Patients were 1:1 matched on disease stage before mCRPC, delay from date of initial diagnosis, and a high-dimensional propensity score. The 3-year discontinuation-free survival (DFS) and overall survival (OS) were compared using Cox models. Costs were calculated according to the payer perspective. In 2014, among 12 951 patients with mCRPC, 2 444 initiated abiraterone acetate as first-line and 1 214 initiated docetaxel; 716 patients per group were matched with good comparability (post-matching C-statistic = 0.6). DFS was significantly higher with abiraterone acetate than docetaxel (p<0.001) with a median of 10.8 months (95% CI: [10.1-11.7]) versus 7.4 [7.0-8.0], as well as OS (p<0.003) with a median of 25.5 months [23.0-27.3] versus 18.5 [17.1-20.7]. The mean monthly total cost and prostate cancer-specific cost per patient during first-line treatment was respectively €5 856 and €4 671 for abiraterone acetate versus €4 017 and €2 213 for docetaxel. Specific monthly costs of abiraterone acetate were €3 575 for the drug itself, €123 for bone metastasis drugs, €686 for hospital and day hospital stays and €287 for other outpatient cares compared to €1 807 for hospital and day hospital stays, including docetaxel cost, €103 for bone metastasis drugs and €303 for other outpatient cares. This study shows that, in mCRPC patients, first-line treatments initiated in 2014 with abiraterone acetate results in a better 3-year DFS and OS compared to docetaxel in real-life setting, with a higher cost from the French health insurance perspective.