Economic Evaluation of Nubeqal for the Treatment of Adult Patients With Non-Metastatic Castration Resistant Prostate Cancer in the Mexican Context

OBJECTIVES: Non-Metastatic Castration Resistant Prostate Cancer (nmCRPC) is a disease that can rapidly progress to the metastatic phase, which reduces the quantity and quality of life of patients and increases the resource use needed to treat the disease, which poses a financial burden for the health care institutions. In Mexico, darolutamide and apalutamide are available to treat nmCRPC patients. According to a matching- adjusted indirect comparison published by Halabi et al. in 2021, both therapies have equivalent results in efficacy. The objective is to assess the cost of treating nmCRPC patients.

METHODS: A cost minimization analysis was developed to estimate the total cost of darolutamide and apalutamide under the public payer´s perspective, hence only direct medical costs were considered. Costs included in the analysis were the acquisition costs of the drugs and the cost of treating the adverse events. Prices were gathered from Mexican official sources as of April 2023. The total cost of treatment was estimated by multiplying the monthly cost of treatment by the median duration of treatment of darolutamide or apalutamide, reported in their pivotal studies (ARAMIS or SPARTAN, respectively). The analysis was conducted under a 3-year time horizon to capture the natural history of the disease and the resource use related to the alternatives; a 5% annual discount rate was applied according to Mexican guidelines. The model was conducted in MicrosoftExcel®2013.

RESULTS: The analysis showed that darolutamide reduced the total costs of the treatment by 8% than apalutamide due to the difference in the median duration of treatment. If adverse events are included, savings are up to 9%, representing $110,852 MXN under a time horizon of 3 years

CONCLUSIONS: The results suggests that darolutamide is an alternative that can provide equivalent efficacy results at a lower cost vs apalutamide in the treatment of nmCRPC adult patients in Mexico.