PCN498 REAL-WORLD EVIDENCE ON THE UTILISATION OF ABIRATERONE AND ENZALUTAMIDE IN IRELAND

Abstract

In Ireland abiraterone and enzalutamide are licensed and reimbursed for the treatment of metastatic castration resistant prostate cancer (mCRPC); initially where the disease has progressed on or after chemotherapy (post-chemo), and later extended to treatment of mCRPC after failure of androgen deprivation therapy where chemotherapy is not yet clinically indicated (pre-chemo). The NCPE did not find abiraterone or enzalutamide to be cost-effective treatments for mCRPC for either indication at the time of evaluation. However both were reimbursed following patient access scheme arrangements (abiraterone for post-chemo in December 2012 then pre-chemo in May 2015, and enzalutamide for post-chemo in August 2014 then pre-chemo in January 2016). We aimed to analyse the post-reimbursement utilisation of abiraterone and enzalutamide in Ireland. Anonymised pharmacy claims data from December 2012 to April 2019 were analysed using R. This data does not include information on treatment indication. We calculated the number of patients receiving either enzalutamide or abiraterone by month and year. We compared this to projections from the pharmacoeconomic evaluations. We also examined treatment sequencing. There were 221 patients in 2013 who received abiraterone. There were 283 patients in 2015 who received enzalutamide. These figures are higher than predicted number of eligible patients in the pharmacoeconomic evaluations. In total between December 2012 and April 2019 there were 1,813 patients who received abiraterone and 1,058 patients who received enzalutamide. Of the 424 patients who received both drugs; 289 patients received abiraterone followed by enzalutamide, and 135 patients received enzalutamide followed by abiraterone. The number of patients receiving abiraterone or enzalutamide in the first years of reimbursement were higher than the number of eligible patients predicted in the pharmacoeconomic evaluations. The budget impact for both drugs was higher than predicted.