Abstract
The 2010 Urological Association Guidelines for Management of Castrate-Resistant Prostate Cancer (CRPC) recommend docetaxel plus prednisone for first-line chemotherapy for symptomatic metastatic CRPC patients who have progressed from hormone therapy. Since 2010, several CRPC agents with better tolerability and longer survival have launched. These improved therapies are causing a shift in practice. The aim of our analysis was to 1) quantify the 3-year mCRPC budget impact for the German health system based on the practice shift, and 2) estimate the cost per additional month of progression-free survival (PFS). A conceptual decision analytic model was developed for the German health system to estimate the impact on direct medical costs of a therapy shift in CRPC over three years. Guideline recommended regimens were represented in model with three lines of therapies: palliative, abiraterone, enzalutamide, docetaxel and cabazitaxel. Progression in therapy was measured as the duration of PFS. A targeted literature search identified US per-patient-per-month costs of docetaxel treated patients (hospitalization=€954, ambulatory=€765, ER=€32, MD=€318) and were adapted to the German health system by applying a published purchase price parity factor. Drug costs were based on Ex-factory pricing. Adverse event rates were used as a proxy to derive relative resource utilization of other treatments. Utilization of CRPC regimens was informed by interviews with EU opinion leaders. The shift in practice pattern is expected to increase the German health system’s 3-year budget by €23 million. The additional cost/month of PFS is estimated to decrease by €99/month from €4,659 for current treatment mix to €4,560 for future treatment mix by year 3. From the German health system’s perspective, a change in practice pattern will result in an increase in total budget of €23 million. The reduction in cost/month of PFS of €99/month indicates the shift in practice will use more efficient therapies.
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