Cost-Effectiveness Analysis of Ga-PSMA-11 PET/CT Imaging Followed by Lu-PSMA-617 vs. Standard of Care in Metastatic Castrate-Resistant Prostate Cancer
Author(s)
Parinita Barman, MPH1, Amit Gupta, MSc1, George Papadopoulos, BSc (Hons)2, Michael Aristides, MSc2, Hemant Rathi, MSc1.
1Skyward Analytics, Gurugram, India, 2Lucid Health Consulting, Sydney, Australia.
1Skyward Analytics, Gurugram, India, 2Lucid Health Consulting, Sydney, Australia.
OBJECTIVES: 68Ga-PSMA-11 is a radiotracer for early detection of prostate-specific membrane antigen (PSMA)-expressing cells, while 177Lu-PSMA-617 is a radioligand therapy that selectively targets these cells. This study evaluates cost-effectiveness of 68Ga-PSMA-11 PET/CT imaging followed by 177Lu-PSMA-617 therapy compared to cabazitaxel or best supportive care (BSC) without 68Ga-PSMA-11 PET/CT, in patients with metastatic castrate resistant prostate cancer (mCRPC) from Australian healthcare perspective.
METHODS: A cost-utility model was developed using hybrid approach: a decision tree to identify patients eligible for 177Lu-PSMA-617 therapy (those testing PSMA positive in 68Ga-PSMA-11 PET/CT imaging), followed by three-state partitioned survival model (PSM) over a 10-year time horizon. The base case was generated using weighted comparator of 75% cabazitaxel and 25% BSC. Efficacy data were derived from the VISION and TheraP trials. Progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier data until 10% of patients remained at risk followed by extrapolation using parameterized survival curves. Costs, utilities, and adverse events were sourced from published literature. Costs and health outcomes were discounted at 5% per annum.
RESULTS: Patients undergoing 68Ga-PSMA-11 PET/CT imaging followed by 177Lu-PSMA-617 therapy accrued an additional 0.193 quality-adjusted life years (QALYs) and 0.257 life-years compared to the weighted comparator arm. The base case ICER of 177Lu-PSMA-617 treatment relative to comparator was $161,741/QALY gained. One-way sensitivity analysis showed that the ICER was most sensitive to variations in the cost of 177Lu-PSMA-617 treatment, followed by the PFS utility value and the proportion of patients receiving cabazitaxel in weighted comparator arm. In scenario analyses, the ICER was most sensitive to changes in the time horizon.
CONCLUSIONS: 68Ga-PSMA-11 PET/CT imaging followed by 177Lu-PSMA-617 offers improved clinical outcomes over standard of care. Integrating radiotracers such as 68Ga-PSMA-11 into PET/CT for early detection of metastatic disease enables more precise, targeted treatment and may help avoid unnecessary local radiotherapy.
METHODS: A cost-utility model was developed using hybrid approach: a decision tree to identify patients eligible for 177Lu-PSMA-617 therapy (those testing PSMA positive in 68Ga-PSMA-11 PET/CT imaging), followed by three-state partitioned survival model (PSM) over a 10-year time horizon. The base case was generated using weighted comparator of 75% cabazitaxel and 25% BSC. Efficacy data were derived from the VISION and TheraP trials. Progression-free survival (PFS) and overall survival were estimated using Kaplan-Meier data until 10% of patients remained at risk followed by extrapolation using parameterized survival curves. Costs, utilities, and adverse events were sourced from published literature. Costs and health outcomes were discounted at 5% per annum.
RESULTS: Patients undergoing 68Ga-PSMA-11 PET/CT imaging followed by 177Lu-PSMA-617 therapy accrued an additional 0.193 quality-adjusted life years (QALYs) and 0.257 life-years compared to the weighted comparator arm. The base case ICER of 177Lu-PSMA-617 treatment relative to comparator was $161,741/QALY gained. One-way sensitivity analysis showed that the ICER was most sensitive to variations in the cost of 177Lu-PSMA-617 treatment, followed by the PFS utility value and the proportion of patients receiving cabazitaxel in weighted comparator arm. In scenario analyses, the ICER was most sensitive to changes in the time horizon.
CONCLUSIONS: 68Ga-PSMA-11 PET/CT imaging followed by 177Lu-PSMA-617 offers improved clinical outcomes over standard of care. Integrating radiotracers such as 68Ga-PSMA-11 into PET/CT for early detection of metastatic disease enables more precise, targeted treatment and may help avoid unnecessary local radiotherapy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE161
Topic
Economic Evaluation
Disease
Genetic, Regenerative & Curative Therapies, Oncology, Personalized & Precision Medicine