PD16-08 COST-EFFECTIVENESS OF SYSTEMIC TREATMENT INTENSIFICATION IN MEN WITH METASTATIC HORMONE-SENSITIVE PROSTATE CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD16-08 COST-EFFECTIVENESS OF SYSTEMIC TREATMENT INTENSIFICATION IN MEN WITH METASTATIC HORMONE-SENSITIVE PROSTATE CANCER Niranjan Sathianathen, Nathan Lawrentschuk, Arun Azad, Badrinath Konety, and Declan Murphy Niranjan SathianathenNiranjan Sathianathen More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , Arun AzadArun Azad More articles by this author , Badrinath KonetyBadrinath Konety More articles by this author , and Declan MurphyDeclan Murphy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003271.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New trials have suggested that treatment intensification with triplet therapy – androgen deprivation therapy, docetaxel and an androgen receptor antagonist – results in improved survival outcomes. However, these novel systemic agents are expensive. Therefore, it is important to assess whether the increased cost is justified in resource-constrained health system. We perform a cost-effective analysis of systemic treatment options for men with metastatic hormone-sensitive prostate cancer based on costs from the United States. METHODS: A state-transition Markov model was developed to simulate the natural progression of metastatic prostate cancer. Model parameters were derived from the published literature and through calibration to observed epidemiological data. The hypothetical cohort of men with metastatic hormone-sensitive prostate cancer could be treated with systemic treatment options that are approved by the FDA: triplet therapy with abiraterone or darolutamide; doublet therapy (abiraterone, apalutamide, enzalutamide or docetaxel with ADT) or ADT only. Once disease progresses to the castration-resistant state, treatment with one of the approved therapies in this setting was initiated. Quality adjusted life years (QALYs) and costs were estimated from a United States health sector perspective. Cost-effectiveness was estimated using the incremental cost effectiveness ratio (ICER). RESULTS: Compared with ADT alone, treatment with doublet therapy with abiraterone, apalutamide, enzalutamide or docetaxel improved quality-adjusted survival by 9.4, 29.6, 17.2 and 1.2 months, respectively. Triplet therapy with abiraterone or darolutamide resulted in an improved quality-adjusted survival of 21.2 and 22.8 months, respectively. Using standard cost-effectiveness metrics, treatment with doublet therapy with docetaxel was high value for money (i.e. is cost effective) with an ICER of $75,546. Doublet therapy with Apalutamide was undominated with an ICER of $245,145 but this is significantly higher than thresholds that would be classified as being cost-effective. Triplet therapy with any strategy was not cost-effective. The cost of darolutamide had to be less than $4,230 (63% discount on listed price) for triplet therapy to be cost-effective. Similarly, the cost of Abiraterone had to be below $4,051 for doublet therapy using it to be cost-effective. CONCLUSIONS: Based on the price of systemic agents in the United States, systemic treatment intensification doublet therapy only using docetaxel was cost-effective. Doublet therapy with androgen-receptor agents or triple therapy was not cost-effective based on standard thresholds. A significant reduction in the price of these agents were required for them to be cost-effective. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e492 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niranjan Sathianathen More articles by this author Nathan Lawrentschuk More articles by this author Arun Azad More articles by this author Badrinath Konety More articles by this author Declan Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...