ECONOMIC IMPACT OF ADDING TALAZOPARIB TO ENZALUTAMIDE IN PATIENTS WITH HRRM MCRPC
Author(s)
Caiden Lukan1, Kangho Suh, PharmD, PhD2;
1West Dundee, IL, USA, 2University of Pittsburgh, Pittsburgh, PA, USA
1West Dundee, IL, USA, 2University of Pittsburgh, Pittsburgh, PA, USA
OBJECTIVES: Talazoparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, combined with the androgen receptor pathway inhibitor enzalutamide, showed superior survival benefits over enzalutamide monotherapy in patients with homologous recombination repair mutation (HRRm)-positive metastatic castration-resistant prostate cancer (mCRPC) in the TALAPRO-2 trial. Despite these clinical benefits, evidence on the economic value of this combination therapy is sparse. This study aimed to assess the lifetime cost-effectiveness of talazoparib plus enzalutamide (TALA+ENZA) compared with enzalutamide (ENZA) alone from a U.S. payer perspective.
METHODS: A partitioned survival model was constructed using progression-free survival (PFS) and overall survival (OS) data from TALAPRO-2. The analysis incorporated costs associated with drug acquisition, adverse event management, disease monitoring, and end-of-life care. Health outcomes were measured in life-years (LYs) and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated comparing TALA+ENZA with ENZA. One-way deterministic and probabilistic sensitivity analyses evaluated parameter uncertainty, while scenario analyses examined the effects of drug price reductions and alternative time horizons.
RESULTS: In the base-case analysis, TALA+ENZA generated 4.84 LYs and 3.25 QALYs versus 3.27 LYs and 1.95 QALYs for ENZA alone, representing incremental gains of 1.57 LYs and 1.30 QALYs. Total lifetime costs were $1,544,791 for TALA+ENZA and $378,932 for ENZA, producing an ICER of $896,159 per QALY gained. Probabilistic sensitivity analysis indicated a 50% likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of approximately $1.0 million per QALY. Sensitivity analyses revealed that health state utilities and drug costs were the primary drivers of model outcomes.
CONCLUSIONS: Among patients with HRRm-positive mCRPC, TALA+ENZA demonstrated meaningful improvements in survival and quality-adjusted outcomes relative to ENZA alone; however, the associated ICER substantially exceeded conventional U.S. WTP thresholds.
METHODS: A partitioned survival model was constructed using progression-free survival (PFS) and overall survival (OS) data from TALAPRO-2. The analysis incorporated costs associated with drug acquisition, adverse event management, disease monitoring, and end-of-life care. Health outcomes were measured in life-years (LYs) and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated comparing TALA+ENZA with ENZA. One-way deterministic and probabilistic sensitivity analyses evaluated parameter uncertainty, while scenario analyses examined the effects of drug price reductions and alternative time horizons.
RESULTS: In the base-case analysis, TALA+ENZA generated 4.84 LYs and 3.25 QALYs versus 3.27 LYs and 1.95 QALYs for ENZA alone, representing incremental gains of 1.57 LYs and 1.30 QALYs. Total lifetime costs were $1,544,791 for TALA+ENZA and $378,932 for ENZA, producing an ICER of $896,159 per QALY gained. Probabilistic sensitivity analysis indicated a 50% likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of approximately $1.0 million per QALY. Sensitivity analyses revealed that health state utilities and drug costs were the primary drivers of model outcomes.
CONCLUSIONS: Among patients with HRRm-positive mCRPC, TALA+ENZA demonstrated meaningful improvements in survival and quality-adjusted outcomes relative to ENZA alone; however, the associated ICER substantially exceeded 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
EE357
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, SDC: Reproductive & Sexual Health