Cost-Effectiveness Analysis of Darolutamide Plus Androgen Deprivation Therapy for Patients With High-Risk Non-Metastatic Castration-Resistant Prostate Cancer in China

OBJECTIVES: Novel antiandrogens have demonstrated clinical benefit for patients with non-metastatic castration resistant prostate cancer (nmCRPC). This study aims to evaluate the cost-effectiveness of darolutamide plus androgen deprivation therapy (ADT) compared with apalutamide+ADT and enzalutamide+ADT, for high-risk nmCRPC, in a Chinese setting.

METHODS: A partitioned survival model was developed to capture time spent by patients in three health states: nmCRPC, metastatic CRPC and death. Clinical outcomes from the ARAMIS, PROSPER and SPARTAN studies were obtained. In the absence of head-to-head studies, indirect treatment comparisons were conducted to capture the comparative effectiveness of darolutamide+ADT vs. apalutamide+ADT and vs. enzalutamide+ADT. The prices of darolutamide, apalutamide and enzalutamide are all assumed to be the same as the pre-NRDL (launch) price of darolutamide in China, since their latest prices are commercially confidential, after recent price negotiations. Other health resources costs, baseline characteristics and treatment patterns for this modeled Chinese cohort were collected through literature and physician interviews, and the utility values were obtained from the literature. A healthcare system perspective was adopted and a discount rate of 5% to both costs and outcomes was applied. Select sensitivity analyses were also performed.

RESULTS: With a 20-year horizon, darolutamide+ADT was associated with lower cost/quality-adjusted life years (QALYs) than apalutamide+ADT and enzalutamide+ADT (202,897 Chinese Yuan (CNY)/QALY vs. 228,998 CNY/QALY and 221,409 CNY/QALY respectively) (exchange rate: 1 USD =6.7871 CNY). Darolutamide+ADT had better health outcomes and lower total costs compared with both apalutamide+ADT (+0.22QALYs and -72,818CNY) and enzalutamide+ADT (+0.09QALYs and -67,451CNY). Across the modeled sensitivity analyses (incl. hazard ratios and drug cost), darolutamide+ADT remained dominant or cost-effective.

CONCLUSIONS: This economic evaluation for the three novel antiandrogens suggested that, in comparison with apalutamide+ADT and enzalutamide+ADT, darolutamide+ADT was a dominant or cost-effective treatment option for patients with high-risk nmCRPC in China.