Darolutamide As a Leading Option to Manage Prostate Cancer

OBJECTIVES: Prostate cancer is a disease with an indolent course, particularly at the earliest stages, and is the most common cause of solid cancers and the fourth most common cause of cancer-related death in men in Portugal. Darolutamide is a new androgen receptor inhibitor indicated in combination with androgen deprivation therapy (ADT) for non-metastatic castration-resistant prostate cancer (nmCRPC) and in combination with ADT and docetaxel for metastatic hormone-sensitive prostate cancer (mHSPC). Our aim was to assess the clinical and economic impact of darolutamide adoption compared with apalutamide and enzalutamide in the Portuguese healthcare system.

METHODS: An analytic decision model, based on the results of the ARAMIS (NCT02200614) and ARASENS (NCT02799602) studies and an expert panel regarding the clinical practice, was developed to compare overall survival (life-years, LY), quality-of-life (QoL) and economic outcomes, of optimizing nmCRPC and mHSPC treatment outcomes and costs using darolutamide in comparison to apalutamide or enzalutamide, for a short and long time-horizon.

RESULTS: In the long run, darolutamide is expected to increase mHSPC patients’ life expectancy by 1.34 years and QoL by 1.66 QALY vs. apalutamide and 1.44 LY and 2.01 QALY vs. enzalutamide. For nmCRPC patients, there is an expected gain of 0.49 LY and 0.25 QALY vs. apalutamide and 0.80 LY and 0.48 QALY vs. enzalutamide over a lifetime time-horizon. In the short run, darolutamide contributes to resource utilization efficiency by decreasing the need for outpatient visits and exams, both in mHSPC and nmCRPC patients over a 2-year time-horizon allowing for important economic savings.

CONCLUSIONS: Darolutamide represents an efficient option for the treatment of prostate cancer with expected significant benefit regarding overall survival and quality of life maximization, while allowing for a reduction in healthcare resources utilization, as well as significant economic savings contributing for the sustainability of the national healthcare system.