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Can Urol Assoc J. 2019 Apr 26:396-403. doi: 10.5489/cuaj.5889. [Epub ahead of print]

Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer.

Author information

1
Cancer Care Ontario, Toronto, ON, Canada.
2
University Health Network, Toronto, ON, Canada.
3
Sunnybrook Hospital, Toronto, ON, Canada.
4
Hamilton Heath Sciences Centre, Hamilton, ON, Canada.
5
UC Davis, Davis, California, United States.

Abstract

INTRODUCTION:

Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone- sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration.

METHODS:

The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature.

RESULTS:

In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases.

CONCLUSIONS:

The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

PMID:
31039109
DOI:
10.5489/cuaj.5889
Free PMC Article

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