Cost-Effectiveness Analysis of Contemporary Advanced Prostate Cancer Treatment Sequences.

Area of Science:

• Oncology
• Health Economics
• Pharmacoeconomics

Background:

• Advanced prostate cancer (PCa) management has novel treatments, including androgen receptor pathway inhibitors (ARPIs).
• Existing health economic analyses of ARPIs lack sequential treatment strategy evaluations.
• A need exists for sequential analyses of ARPIs in advanced PCa management.

Purpose of the Study:

• To conduct sequential health economic analyses of novel treatments for advanced prostate cancer.
• To identify the most cost-effective treatment sequences for advanced PCa using ARPIs.
• To evaluate the cost-effectiveness of ARPIs across different stages of advanced PCa.

Main Methods:

• Developed a Monte Carlo Markov model to simulate advanced PCa management to end-of-life.
• Modeled patients progressing from metastatic castration-sensitive PCa (mCSPC) and nonmetastatic castration-sensitive PCa (nmCSPC) to metastatic castration-resistant PCa (mCRPC).
• Simulated admissible treatment sequences over a 15-year horizon based on guidelines and literature.

Main Results:

• The most cost-effective use of ARPIs is early in advanced PCa for a cost-effectiveness threshold (CET) of CAD 100K per QALY.
• For a CET of CAD 50K per QALY, early ARPI use is most cost-effective for mCSPC-starting patients, but not nmCSPC-starting.
• Abiraterone emerged as the most cost-effective ARPI at current Canadian prices, primarily due to its lower cost.

Conclusions:

• The optimal strategy for ARPI use in advanced PCa is initiating treatment as early as possible.
• Sequential analysis reveals specific cost-effectiveness benefits of early ARPI initiation depending on patient's initial disease state and CET.
• Abiraterone represents the most economically favorable ARPI option in the Canadian context.