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Article: A Cost-Effectiveness Analysis of Systemic Therapy for Metastatic Hormone-Sensitive Prostate Cancer
Title | A Cost-Effectiveness Analysis of Systemic Therapy for Metastatic Hormone-Sensitive Prostate Cancer |
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Authors | |
Keywords | prostate cancer abiraterone (AA) enzalutamide (ENZ) apalutamide docetaxel |
Issue Date | 2021 |
Publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology |
Citation | Frontiers in Oncology, 2021, v. 11, p. article no. 627083 How to Cite? |
Abstract | Background: Currently, approved first-line treatment options of metastatic hormone-sensitive prostate cancer (mHSPC) include (1) androgen deprivation therapy (ADT) alone, ADT plus one of the following: (2) docetaxel, (3) abiraterone, (4) enzalutamide, and (5) apalutamide. The high cost of novel androgen receptor pathway inhibitors warrants an understanding of the combinations’ value by considering both efficacy and cost.
Objective: This study aimed to compare the cost-effectiveness of these five treatment options in mHSPC from the US payer perspective to guide treatment sequence.
Methods: A Markov model was developed to compare the lifetime cost and effectiveness of these five first-line treatment options for mHSPC using outcomes data from published literature. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were obtained from the Veterans Affairs Pharmaceutical Catalog. We extrapolated survival beyond closure of the trials.
Outcome Measurements and Statistical Analysis: Life-years, QALYs, lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariable, 2-way, and probabilistic sensitivity analyses were performed to evaluate parameter uncertainty. A willingness-to-pay (WTP) threshold of US$100,000 per QALY was used.
Results: Compared to ADT alone, docetaxel plus ADT provided a 0.28 QALY gain at an ICER of US$12,870 per QALY. Abiraterone plus ADT provided an additional 1.70 QALYs against docetaxel plus ADT, with an ICER of US$38,897 per QALY. Compared to abiraterone plus ADT, enzalutamide plus ADT provided an additional 0.87 QALYs at an ICER of US$509,813 per QALY. Apalutamide plus ADT was strongly dominated by enzalutamide plus ADT. Given the WTP threshold of US$100,000 per QALY, abiraterone plus ADT represented high-value health care.
Conclusions: Abiraterone plus ADT is the preferred treatment option for men with mHSPC at a WTP threshold of US$100,000 per QALY. |
Persistent Identifier | http://hdl.handle.net/10722/305308 |
ISSN | 2023 Impact Factor: 3.5 2023 SCImago Journal Rankings: 1.066 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Sung, WWY | - |
dc.contributor.author | Choi, HCW | - |
dc.contributor.author | Luk, PHY | - |
dc.contributor.author | So, TH | - |
dc.date.accessioned | 2021-10-20T10:07:35Z | - |
dc.date.available | 2021-10-20T10:07:35Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Frontiers in Oncology, 2021, v. 11, p. article no. 627083 | - |
dc.identifier.issn | 2234-943X | - |
dc.identifier.uri | http://hdl.handle.net/10722/305308 | - |
dc.description.abstract | Background: Currently, approved first-line treatment options of metastatic hormone-sensitive prostate cancer (mHSPC) include (1) androgen deprivation therapy (ADT) alone, ADT plus one of the following: (2) docetaxel, (3) abiraterone, (4) enzalutamide, and (5) apalutamide. The high cost of novel androgen receptor pathway inhibitors warrants an understanding of the combinations’ value by considering both efficacy and cost. Objective: This study aimed to compare the cost-effectiveness of these five treatment options in mHSPC from the US payer perspective to guide treatment sequence. Methods: A Markov model was developed to compare the lifetime cost and effectiveness of these five first-line treatment options for mHSPC using outcomes data from published literature. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were obtained from the Veterans Affairs Pharmaceutical Catalog. We extrapolated survival beyond closure of the trials. Outcome Measurements and Statistical Analysis: Life-years, QALYs, lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariable, 2-way, and probabilistic sensitivity analyses were performed to evaluate parameter uncertainty. A willingness-to-pay (WTP) threshold of US$100,000 per QALY was used. Results: Compared to ADT alone, docetaxel plus ADT provided a 0.28 QALY gain at an ICER of US$12,870 per QALY. Abiraterone plus ADT provided an additional 1.70 QALYs against docetaxel plus ADT, with an ICER of US$38,897 per QALY. Compared to abiraterone plus ADT, enzalutamide plus ADT provided an additional 0.87 QALYs at an ICER of US$509,813 per QALY. Apalutamide plus ADT was strongly dominated by enzalutamide plus ADT. Given the WTP threshold of US$100,000 per QALY, abiraterone plus ADT represented high-value health care. Conclusions: Abiraterone plus ADT is the preferred treatment option for men with mHSPC at a WTP threshold of US$100,000 per QALY. | - |
dc.language | eng | - |
dc.publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology | - |
dc.relation.ispartof | Frontiers in Oncology | - |
dc.rights | This Document is Protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | prostate cancer | - |
dc.subject | abiraterone (AA) | - |
dc.subject | enzalutamide (ENZ) | - |
dc.subject | apalutamide | - |
dc.subject | docetaxel | - |
dc.title | A Cost-Effectiveness Analysis of Systemic Therapy for Metastatic Hormone-Sensitive Prostate Cancer | - |
dc.type | Article | - |
dc.identifier.email | Choi, HCW: hcchoi@hku.hk | - |
dc.identifier.email | So, TH: sth495@hku.hk | - |
dc.identifier.authority | Choi, HCW=rp02815 | - |
dc.identifier.authority | So, TH=rp01981 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3389/fonc.2021.627083 | - |
dc.identifier.pmid | 33718198 | - |
dc.identifier.pmcid | PMC7943717 | - |
dc.identifier.scopus | eid_2-s2.0-85102365612 | - |
dc.identifier.hkuros | 327880 | - |
dc.identifier.volume | 11 | - |
dc.identifier.spage | article no. 627083 | - |
dc.identifier.epage | article no. 627083 | - |
dc.identifier.isi | WOS:000626894200001 | - |
dc.publisher.place | Switzerland | - |