APALUTAMIDE (APA) AS FIRST OPTION TO METASTATIC HORMONE-SENSITIVE PROSTATE CANCER (MHSPC) REPRESENTS COST-EFFECTIVE TREATMENT SEQUENCES TO HEALTH SYSTEMS
Author(s)
Lucas Silva, MSc, Thiago Nogueira, MSc, Larissa Pando, MD, Graziela Vidal, MSc, Bianca Montone, BSc, Mariana Macedo, MSc.
Johnson & Johnson, Sao Paulo, Brazil.
Johnson & Johnson, Sao Paulo, Brazil.
OBJECTIVES: To assess cost-effectiveness of APA plus androgen deprivation therapy (ADT) versus enzalutamide (ENZ) or darolutamide (DARO) plus ADT as first option for mHSPC considering treatment sequences.
METHODS: Based on meta-analysis by the National Committee for Health Technology Incorporation (CONITEC) overall survival (OS) and progression free survival (PFS), we performed economic analysis comparing costs per life-year gained (LYG) between sequences of APA versus ENZ or DARO as therapy for mHSPC, assuming identical metastatic castration-resistant prostate cancer (mCRPC) drugs sequence across scenarios. We included Brazilian drug-related costs: acquisition, administration and cardiovascular toxicity management. OS from initial mHSPC therapy was considered full duration of patient journey since this phase has better prognosis, while PFS determined progression timing and initiation of mCRPC treatment, comprising up to three pharmacological lines. Therefore, mCRPC duration was calculated as OS minus PFS, adjusted according to following therapies PFS values.
RESULTS: Overall, APA+ADT accounted for 46 cost-effective scenarios (96%) comparing sequences initiated by ENZ+ADT or DARO+ADT.
All scenarios (100%;n=12) starting with APA+ADT versus ENZ+ADT presented savings (BRL 1,710 to 3,581/LYG). The two most economic sequences were APA+ADT, ABI+ADT, CABA+ADT and BSC, and APA+ADT, CABA+ADT, ABI+ADT and BSC - where ABI is abiraterone acetate plus prednisone; CABA, cabazitaxel; and BSC, best supportive care (used when no therapy options remain because of advanced disease stage). In both cases, APA provided 0.42 LYG. Ninety-four percent (94%;n=34) of APA+ADT versus DARO+ADT scenarios resulted in savings (BRL 1,283 to 8,314/LYG). The two most cost-effective sequences were APA+ADT, ENZ+ADT, CABA+ADT and BSC, and APA+ADT, CABA+ADT, ENZ+ADT and BSC; both offering 1.08 LYG. The two non-cost-effective sequences used only chemotherapy and BSC for mCRPC, meaning lower cost but 1 year less of life.
CONCLUSIONS: APA for mHSPC represents a cost-effective strategy within prostate cancer therapeutic sequences, keeping positive survival outcomes, and decision-makers can select appropriate treatment based on it.
METHODS: Based on meta-analysis by the National Committee for Health Technology Incorporation (CONITEC) overall survival (OS) and progression free survival (PFS), we performed economic analysis comparing costs per life-year gained (LYG) between sequences of APA versus ENZ or DARO as therapy for mHSPC, assuming identical metastatic castration-resistant prostate cancer (mCRPC) drugs sequence across scenarios. We included Brazilian drug-related costs: acquisition, administration and cardiovascular toxicity management. OS from initial mHSPC therapy was considered full duration of patient journey since this phase has better prognosis, while PFS determined progression timing and initiation of mCRPC treatment, comprising up to three pharmacological lines. Therefore, mCRPC duration was calculated as OS minus PFS, adjusted according to following therapies PFS values.
RESULTS: Overall, APA+ADT accounted for 46 cost-effective scenarios (96%) comparing sequences initiated by ENZ+ADT or DARO+ADT.
All scenarios (100%;n=12) starting with APA+ADT versus ENZ+ADT presented savings (BRL 1,710 to 3,581/LYG). The two most economic sequences were APA+ADT, ABI+ADT, CABA+ADT and BSC, and APA+ADT, CABA+ADT, ABI+ADT and BSC - where ABI is abiraterone acetate plus prednisone; CABA, cabazitaxel; and BSC, best supportive care (used when no therapy options remain because of advanced disease stage). In both cases, APA provided 0.42 LYG. Ninety-four percent (94%;n=34) of APA+ADT versus DARO+ADT scenarios resulted in savings (BRL 1,283 to 8,314/LYG). The two most cost-effective sequences were APA+ADT, ENZ+ADT, CABA+ADT and BSC, and APA+ADT, CABA+ADT, ENZ+ADT and BSC; both offering 1.08 LYG. The two non-cost-effective sequences used only chemotherapy and BSC for mCRPC, meaning lower cost but 1 year less of life.
CONCLUSIONS: APA for mHSPC represents a cost-effective strategy within prostate cancer therapeutic sequences, keeping positive survival outcomes, and decision-makers can select appropriate treatment based on it.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE151
Topic
Economic Evaluation
Disease
SDC: Oncology