Presentation (CTI)

OBJECTIVES: OBJECTIVES: Sarcopenia affects 10-16% of US adults aged ≥65 years, imposing substantial functional decline and healthcare costs. Enobosarm, a selective androgen receptor modulator (SARM), improved muscle mass and physical function in Phase II trials but lacks pharmacoeconomic evaluation. We assessed the cost-utility of enobosarm versus resistance exercise training (RET) and no treatment from a US payer perspective.
METHODS: METHODS: A three-arm decision-analytic model with a 3-year horizon compared enobosarm (hypothetical payer cost $720/year), RET ($780/year), and no treatment in community-dwelling US adults aged ≥65 with sarcopenia. Health state utilities were derived from published EQ-5D-5L norms and sarcopenia-specific studies. Adverse event probabilities were sourced from Phase II trial data and systematic reviews. All costs are in 2026 USD (BLS medical care CPI-adjusted). Probabilistic sensitivity analysis (PSA) used 10,000 Monte Carlo iterations. Expected value of perfect information (EVPI) was calculated at a willingness-to-pay (WTP) threshold of $100,000/QALY.
RESULTS: RESULTS: Enobosarm dominated RET in the base case (cost: $2,196 vs. $2,355; QALYs: 2.171 vs. 2.136). Versus no treatment, the ICER was $45,923/QALY, below the $100,000/QALY threshold. In PSA, enobosarm was cost-effective versus RET in 74% of iterations and versus no treatment in 58% of iterations at WTP $100,000/QALY. EVPI was $6,748/patient, indicating substantial residual decision uncertainty. One-way sensitivity analysis demonstrated dominance over RET was preserved until enobosarm exceeds approximately $1,800/year.
CONCLUSIONS: CONCLUSIONS: At a hypothetical payer price of $720/year, enobosarm is simultaneously lower-cost and more effective than RET, and cost-effective versus no treatment for sarcopenia in US older adults. These findings support pharmacoeconomic evaluation alongside regulatory and formulary decision-making for emerging SARM therapies.