COST EFFECTIVENESS ENZALUTAMIDE VERSUS ABIRATERONE IN METASTATIC CASTRATION-RESISTANT PROSTATE CANCER: A MARKOV MODEL ANALYSIS FROM INDIAN HEALTHCARE PERSPECTIVE
Author(s)
Anna Ankita, PharmD1, Arathi Viswam, PharmD2, Shruthi Ashok Kumar, PharmD3, Norah Elsa Shynu3.
1Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India, 3M S Ramaiah University Of Applied Sciences, Bengaluru, India.
1Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India, 3M S Ramaiah University Of Applied Sciences, Bengaluru, India.
OBJECTIVES: To assess the cost-effectiveness of enzalutamide versus abiraterone for the treatment of metastatic castration-resistant prostate cancer (mCRPC) by estimating costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) from the Indian healthcare payer perspective.
METHODS: A Markov model was developed to simulate disease progression through three mutually exclusive health states: progression-free disease, progressed disease, and death. Transition probabilities were derived from published clinical evidence, while utility values were used to estimate quality-adjusted life years (QALYs). Direct medical costs, including drug acquisition and disease management costs, were incorporated into the analysis. Outcomes were assessed in terms of total costs, QALYs, net monetary benefit (NMB), and incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of INR 200,000 per QALY gained was applied. Probabilistic sensitivity analysis with 10,000 simulations was conducted to evaluate parameter uncertainty and model robustness.
RESULTS: Enzalutamide generated 2.36 QALYs at a total cost of INR 13,491,134, whereas abiraterone generated 1.91 QALYs at a cost of INR 3,287,630. The incremental gain of 0.45 QALYs was associated with an additional cost of INR 10,203,505, resulting in an ICER of INR 22,807,173 per QALY gained. Sensitivity analyses identified treatment costs and utility values as the primary determinants of cost-effectiveness outcomes.
CONCLUSIONS: Although enzalutamide provides superior health benefits compared with abiraterone, its substantially higher cost results in an ICER well above the accepted willingness-to-pay threshold, making it unlikely to be a cost-effective treatment option for mCRPC in India under current pricing conditions.
METHODS: A Markov model was developed to simulate disease progression through three mutually exclusive health states: progression-free disease, progressed disease, and death. Transition probabilities were derived from published clinical evidence, while utility values were used to estimate quality-adjusted life years (QALYs). Direct medical costs, including drug acquisition and disease management costs, were incorporated into the analysis. Outcomes were assessed in terms of total costs, QALYs, net monetary benefit (NMB), and incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of INR 200,000 per QALY gained was applied. Probabilistic sensitivity analysis with 10,000 simulations was conducted to evaluate parameter uncertainty and model robustness.
RESULTS: Enzalutamide generated 2.36 QALYs at a total cost of INR 13,491,134, whereas abiraterone generated 1.91 QALYs at a cost of INR 3,287,630. The incremental gain of 0.45 QALYs was associated with an additional cost of INR 10,203,505, resulting in an ICER of INR 22,807,173 per QALY gained. Sensitivity analyses identified treatment costs and utility values as the primary determinants of cost-effectiveness outcomes.
CONCLUSIONS: Although enzalutamide provides superior health benefits compared with abiraterone, its substantially higher cost results in an ICER well above the accepted willingness-to-pay threshold, making it unlikely to be a cost-effective treatment option for mCRPC in India under current pricing conditions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA259
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Decision & Deliberative Processes
Disease
Oncology