Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.

Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.

<h4>Background</h4>Docetaxel is an established first-line therapy to treat metastatic castration-resistant prostate cancer (mCRPC). Recently, abiraterone and cabazitaxel were approved for use after docetaxel failure, with improved survival. National Institute for Health and Clinical Exce...

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Autores principales: Lixian Zhong, Vickie Pon, Sandy Srinivas, Nicole Nguyen, Meghan Frear, Sherry Kwon, Cynthia Gong, Robert Malmstrom, Leslie Wilson
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Publicado: Public Library of Science (PLoS) 2013
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Acceso en línea:https://doaj.org/article/4604469ff4ee41d0af833205905effe0
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spelling oai:doaj.org-article:4604469ff4ee41d0af833205905effe02021-11-18T07:44:34ZTherapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.1932-620310.1371/journal.pone.0064275https://doaj.org/article/4604469ff4ee41d0af833205905effe02013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23717582/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Docetaxel is an established first-line therapy to treat metastatic castration-resistant prostate cancer (mCRPC). Recently, abiraterone and cabazitaxel were approved for use after docetaxel failure, with improved survival. National Institute for Health and Clinical Excellence (NICE) preliminary recommendations were negative for both abiraterone (now positive in final recommendation) and cabazitaxel (negative in final recommendation).<h4>Objective</h4>To evaluate the cost-effectiveness of abiraterone, cabazitaxel, mitoxantrone and prednisone for mCRPC treatment in US.<h4>Methods</h4>A decision-tree model was constructed to compare the two mCRPC treatments versus two placebos over 18 months from a societal perspective. Chance nodes include baseline pain as a severity indicator, grade III/IV side-effects, and survival at 18 months. Probabilities, survival and health utilities were from published studies. Model cost inputs included drug treatment, side-effect management and prevention, radiation for pain, and death associated costs in 2010 US dollars.<h4>Results</h4>Abiraterone is a cost-effective choice at $94K/QALY (quality adjusted life years) compared to placebo in our base-case analysis. Cabazitaxel and abiraterone are the most effective, yet also most expensive agents. The incremental cost-effectiveness ratios (ICER) at base-case are $101K/QALY (extended dominated) for mitoxantrone vs. placebo, $91K/QALY for abiraterone vs. mitoxantrone, $956K/QALY for cabazitaxel vs. abiraterone. Abiraterone becomes less cost-effective as its AWP increases, or if the cost of mitoxantrone side-effect management decreases. Increases in the percentage of patients with baseline pain leads to an increased ICER for both mitoxantrone and abiraterone, but mitoxantrone does relatively better. Cabazitaxel remains not cost-effective.<h4>Conclusion</h4>Our base case model suggests that abiraterone is a cost-effective option in docetaxel-refractory mCRPC patients. Newer treatments will also need a CEA assessment compared to abiraterone.Lixian ZhongVickie PonSandy SrinivasNicole NguyenMeghan FrearSherry KwonCynthia GongRobert MalmstromLeslie WilsonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e64275 (2013)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Lixian Zhong
Vickie Pon
Sandy Srinivas
Nicole Nguyen
Meghan Frear
Sherry Kwon
Cynthia Gong
Robert Malmstrom
Leslie Wilson
Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
description <h4>Background</h4>Docetaxel is an established first-line therapy to treat metastatic castration-resistant prostate cancer (mCRPC). Recently, abiraterone and cabazitaxel were approved for use after docetaxel failure, with improved survival. National Institute for Health and Clinical Excellence (NICE) preliminary recommendations were negative for both abiraterone (now positive in final recommendation) and cabazitaxel (negative in final recommendation).<h4>Objective</h4>To evaluate the cost-effectiveness of abiraterone, cabazitaxel, mitoxantrone and prednisone for mCRPC treatment in US.<h4>Methods</h4>A decision-tree model was constructed to compare the two mCRPC treatments versus two placebos over 18 months from a societal perspective. Chance nodes include baseline pain as a severity indicator, grade III/IV side-effects, and survival at 18 months. Probabilities, survival and health utilities were from published studies. Model cost inputs included drug treatment, side-effect management and prevention, radiation for pain, and death associated costs in 2010 US dollars.<h4>Results</h4>Abiraterone is a cost-effective choice at $94K/QALY (quality adjusted life years) compared to placebo in our base-case analysis. Cabazitaxel and abiraterone are the most effective, yet also most expensive agents. The incremental cost-effectiveness ratios (ICER) at base-case are $101K/QALY (extended dominated) for mitoxantrone vs. placebo, $91K/QALY for abiraterone vs. mitoxantrone, $956K/QALY for cabazitaxel vs. abiraterone. Abiraterone becomes less cost-effective as its AWP increases, or if the cost of mitoxantrone side-effect management decreases. Increases in the percentage of patients with baseline pain leads to an increased ICER for both mitoxantrone and abiraterone, but mitoxantrone does relatively better. Cabazitaxel remains not cost-effective.<h4>Conclusion</h4>Our base case model suggests that abiraterone is a cost-effective option in docetaxel-refractory mCRPC patients. Newer treatments will also need a CEA assessment compared to abiraterone.
format article
author Lixian Zhong
Vickie Pon
Sandy Srinivas
Nicole Nguyen
Meghan Frear
Sherry Kwon
Cynthia Gong
Robert Malmstrom
Leslie Wilson
author_facet Lixian Zhong
Vickie Pon
Sandy Srinivas
Nicole Nguyen
Meghan Frear
Sherry Kwon
Cynthia Gong
Robert Malmstrom
Leslie Wilson
author_sort Lixian Zhong
title Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
title_short Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
title_full Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
title_fullStr Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
title_full_unstemmed Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
title_sort therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis.
publisher Public Library of Science (PLoS)
publishDate 2013
url https://doaj.org/article/4604469ff4ee41d0af833205905effe0
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AT nicolenguyen therapeuticoptionsindocetaxelrefractorymetastaticcastrationresistantprostatecanceracosteffectivenessanalysis
AT meghanfrear therapeuticoptionsindocetaxelrefractorymetastaticcastrationresistantprostatecanceracosteffectivenessanalysis
AT sherrykwon therapeuticoptionsindocetaxelrefractorymetastaticcastrationresistantprostatecanceracosteffectivenessanalysis
AT cynthiagong therapeuticoptionsindocetaxelrefractorymetastaticcastrationresistantprostatecanceracosteffectivenessanalysis
AT robertmalmstrom therapeuticoptionsindocetaxelrefractorymetastaticcastrationresistantprostatecanceracosteffectivenessanalysis
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