COST-EFFECTIVENESS OF ABIRATERONE, APALUTAMIDE, ENZALUTAMIDE, AND DOCETAXEL DOUBLETS FOR METASTATIC HORMONE-SENSITIVE PROSTATE CANCER: A REAL-WORLD EVIDENCE ANALYSIS
Author(s)
Ifechukwu B. Nwogu, MPH1, Noemi Kreif, MA, MSc, PhD1, Hiba Khan, MD, MPH2, Ruth Etzioni, MSc, PhD3, Josh J. Carlson, MPH, PhD1;
1University of Washington, Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Seattle, WA, USA, 2University of Washington School of Medicine, Division of Hematology and Oncology, Seattle, WA, USA, 3Fred Hutch Cancer Cancer, Seattle, WA, USA
1University of Washington, Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, Seattle, WA, USA, 2University of Washington School of Medicine, Division of Hematology and Oncology, Seattle, WA, USA, 3Fred Hutch Cancer Cancer, Seattle, WA, USA
OBJECTIVES: Existing economic evaluations of metastatic hormone-sensitive prostate cancer (mHSPC) treatments rely primarily on clinical trial evidence, which may not reflect real-world value. This study evaluates the cost-effectiveness of available doublet therapies for mHSPC using real-world survival data.
METHODS: We employed a three-state partitioned survival model (progression-free, progressed, and death) to estimate lifetime costs and benefits of abiraterone, apalutamide, enzalutamide, and docetaxel, each combined with androgen deprivation therapy (ADT), from the US healthcare sector perspective. Parametric survival distributions (Weibull, gamma, generalized gamma, exponential, lognormal, and log-logistic) were fit to propensity score-weighted Kaplan-Meier curves derived from treatment-specific overall survival and progression-free survival data of 9,141 mHSPC patients (mean age of 69 years) from Komodo Health claims database. Optimal distributions were selected based on Akaike Information Criterion, visual inspection, and clinical plausibility. Drug and administration costs were obtained from Veterans Affairs Federal Supply Schedule (apalutamide, enzalutamide), CMS National Average Drug Acquisition Cost (abiraterone), CMS average sales price (docetaxel, ADT), and CMS Physician Fee Schedule. Health state costs, utilities, and adverse event disutilities were derived from published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) in cost per quality-adjusted life year (QALY), with 3% discounting applied to costs and QALYs. Probabilistic sensitivity analysis assessed model uncertainty.
RESULTS: Abiraterone generated 5.38 QALYs at $716,370, compared to apalutamide (5.51 QALYs; $1,165,714), enzalutamide (5.54 QALYs; $1,160,086), and docetaxel (4.96 QALYs; $749,263). Docetaxel and apalutamide were dominated by abiraterone and enzalutamide, respectively. The ICER for enzalutamide versus abiraterone was $2,773,225 per QALY. Abiraterone remained the most cost-effective across all observed willingness-to-pay thresholds.
CONCLUSIONS: Using real-world survival data, abiraterone was the most cost-effective first-line treatment for mHSPC, driven primarily by generic drug availability, and offering superior value compared to alternative androgen receptor pathway inhibitors and docetaxel-based regimens.
METHODS: We employed a three-state partitioned survival model (progression-free, progressed, and death) to estimate lifetime costs and benefits of abiraterone, apalutamide, enzalutamide, and docetaxel, each combined with androgen deprivation therapy (ADT), from the US healthcare sector perspective. Parametric survival distributions (Weibull, gamma, generalized gamma, exponential, lognormal, and log-logistic) were fit to propensity score-weighted Kaplan-Meier curves derived from treatment-specific overall survival and progression-free survival data of 9,141 mHSPC patients (mean age of 69 years) from Komodo Health claims database. Optimal distributions were selected based on Akaike Information Criterion, visual inspection, and clinical plausibility. Drug and administration costs were obtained from Veterans Affairs Federal Supply Schedule (apalutamide, enzalutamide), CMS National Average Drug Acquisition Cost (abiraterone), CMS average sales price (docetaxel, ADT), and CMS Physician Fee Schedule. Health state costs, utilities, and adverse event disutilities were derived from published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) in cost per quality-adjusted life year (QALY), with 3% discounting applied to costs and QALYs. Probabilistic sensitivity analysis assessed model uncertainty.
RESULTS: Abiraterone generated 5.38 QALYs at $716,370, compared to apalutamide (5.51 QALYs; $1,165,714), enzalutamide (5.54 QALYs; $1,160,086), and docetaxel (4.96 QALYs; $749,263). Docetaxel and apalutamide were dominated by abiraterone and enzalutamide, respectively. The ICER for enzalutamide versus abiraterone was $2,773,225 per QALY. Abiraterone remained the most cost-effective across all observed willingness-to-pay thresholds.
CONCLUSIONS: Using real-world survival data, abiraterone was the most cost-effective first-line treatment for mHSPC, driven primarily by generic drug availability, and offering superior value compared to alternative androgen receptor pathway inhibitors and docetaxel-based regimens.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE46
Topic
Economic Evaluation
Disease
SDC: Oncology