Abstract
Previous cost-effectiveness analyses (CEAs) of abiraterone for castration-resistant prostate cancer (CRPC) patients have not shown favorable results for this new drug. These CEAs were generally conducted based on models used in clinical trials, where comparisons were made with patients given placebos. However, details on any other therapies provided to the comparison groups were not analyzed. These additional therapies should be considered when conducting CEAs to ensure better applications to clinical practice and policymaking. The objective of this study was to elucidate the actual therapies provided to CRPC patients using real-world claims data. We obtained anonymized computerized health care claims data of Japanese prostate cancer patients from the Japan Medical Data Center. This database comprises data from more than 2.5 million insured persons aged below 75 years from over 50 companies between January 2005 and June 2013. From among the prostate cancer patients, we identified CRPC patients as those who had been administered docetaxel, and further investigated their treatments and health care costs. Health care costs were estimated using a regression model accounting for variations in inpatient care, chemotherapies, death, and age. We identified 2138 prostate cancer patients, 36 of whom had been administered docetaxel. We excluded patients diagnosed with other cancers, resulting in a final sample of 18 cases. Of these, 66.7 % were administered other types of chemotherapy, which had not been considered in the control groups in most previous CEAs. We estimated mean health care costs for CRPC to be approximately US$952 per patient per month, and found that these costs were significantly affected by inpatient care and chemotherapy use. Actual therapies include a variety of treatments for CRPC patients, including various types of chemotherapy. Our study estimated health care costs based on real-world claims data. This study contributes to future CEAs by not only providing an estimate of health care costs for these patients, but also demonstrating that the actual therapies provided to comparison groups should be considered when conducting CEAs.
Highlights
Due to increasing health care costs, there is growing interest in cost control measures such as the use of generic drugs and efficient resource allocations
Prostate cancer patients We identified 2138 prostate cancer patients from the database
The first exclusion criterion was to focus the study on prostate cancer patients, while the second exclusion criterion enabled the analysis of post-docetaxel treatments
Summary
Due to increasing health care costs, there is growing interest in cost control measures such as the use of generic drugs and efficient resource allocations. Health technology assessments (HTA) are one of the current methods used to guide resource allocations in Kunisawa et al SpringerPlus (2015) 4:624 health care. HTAs are needed to evaluate whether new drugs and new technologies are sufficiently cost-effective to introduce into current markets. The United Kingdom’s National Institute for Health and Care Excellence (NICE) uses this assessment method to evaluate the cost-effectiveness of new drugs and medical procedures. The Japanese government has shown interest in this assessment method, and is currently planning to introduce CEAs to guide the control of drug and medical device prices, as well as to inform policymaking concerning reimbursements (Ministry of Health, Labour and Welfare 2014a)
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