COST-EFFECTIVENESS ANALYSIS OF ¹77LU-PSMA-617 VERSUS CABAZITAXEL IN METASTATIC CASTRATION-RESISTANT PROSTATE CANCER: AN ANALYSIS BASED ON REAL-WORLD DATA AND THERAP TRIAL
Author(s)
Kemal Gogebakan, PhD1, Natalia Kunst, MPH, MSc, PhD2, Ruth Etzioni, PhD1;
1Fred Hutchinson Cancer Center, Seattle, WA, USA, 2University of York, Heslington, United Kingdom
1Fred Hutchinson Cancer Center, Seattle, WA, USA, 2University of York, Heslington, United Kingdom
OBJECTIVES: The TheraP trial demonstrated that 177Lu-PSMA-617 improved progression-free survival compared with cabazitaxel, with no significant difference in overall survival. However, 177Lu-PSMA-617 was associated with fewer grade ≥3 adverse events, better patient-reported outcomes, and lower healthcare utilization. This study evaluated whether these improvements translate into cost-effectiveness of 177Lu-PSMA-617 compared with cabazitaxel.
METHODS: A partitioned survival model was developed to estimate costs and health outcomes of 177Lu-PSMA-617 versus cabazitaxel from a U.S. healthcare system perspective over a 60-month horizon. Overall and progression-free survival for 177Lu-PSMA-617 were derived from a retrospective cohort (median age, 73 years; IQR, 68-78), and relative treatment effects (hazard ratios) from the TheraP trial were applied to generate outcomes for cabazitaxel group. Health-state utilities, adverse event disutilities, and costs were obtained from published literature. Model outcomes included total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) at willingness-to-pay (WTP) thresholds up to $200,000 per QALY.
RESULTS: In the base-case analysis, 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel, with an ICER of $358,990. Deterministic sensitivity analysis showed that cost-effectiveness results were most sensitive to the overall survival hazard ratio, the per-cycle cost of 177Lu-PSMA-617, and the per-cycle cost of cabazitaxel. 177Lu-PSMA-617 would become cost-effective if the per-cycle treatment cost decreased to $27,656 at a WTP threshold of $200,000/QALY or if the overall survival hazard ratio improved to 0.78. In probabilistic sensitivity analysis, 177Lu-PSMA-617 was cost-effective in 15.6% of 10,000 Monte Carlo simulations at a WTP of $200,000/QALY, 4.1% at $100,000/QALY, and 2.2% at $50,000/QALY.
CONCLUSIONS: Although 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel in the base-case scenario, it may achieve cost-effectiveness under more favorable assumptions of survival benefit or reduced per-cycle cost. The probabilistic analysis further highlights substantial uncertainty, with a low probability of cost-effectiveness at conventional U.S. WTP thresholds.
METHODS: A partitioned survival model was developed to estimate costs and health outcomes of 177Lu-PSMA-617 versus cabazitaxel from a U.S. healthcare system perspective over a 60-month horizon. Overall and progression-free survival for 177Lu-PSMA-617 were derived from a retrospective cohort (median age, 73 years; IQR, 68-78), and relative treatment effects (hazard ratios) from the TheraP trial were applied to generate outcomes for cabazitaxel group. Health-state utilities, adverse event disutilities, and costs were obtained from published literature. Model outcomes included total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) at willingness-to-pay (WTP) thresholds up to $200,000 per QALY.
RESULTS: In the base-case analysis, 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel, with an ICER of $358,990. Deterministic sensitivity analysis showed that cost-effectiveness results were most sensitive to the overall survival hazard ratio, the per-cycle cost of 177Lu-PSMA-617, and the per-cycle cost of cabazitaxel. 177Lu-PSMA-617 would become cost-effective if the per-cycle treatment cost decreased to $27,656 at a WTP threshold of $200,000/QALY or if the overall survival hazard ratio improved to 0.78. In probabilistic sensitivity analysis, 177Lu-PSMA-617 was cost-effective in 15.6% of 10,000 Monte Carlo simulations at a WTP of $200,000/QALY, 4.1% at $100,000/QALY, and 2.2% at $50,000/QALY.
CONCLUSIONS: Although 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel in the base-case scenario, it may achieve cost-effectiveness under more favorable assumptions of survival benefit or reduced per-cycle cost. The probabilistic analysis further highlights substantial uncertainty, with a low probability of cost-effectiveness at conventional U.S. WTP thresholds.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE49
Topic
Economic Evaluation
Disease
SDC: Oncology