BACKGROUN & OBJECTIVES

Of patients diagnosed with prostate cancer, some experi­ence disease progression to metastatic castration-resistant prostate cancer (mCRPC). A novel therapy, Abiraterone acetate is a selective inhibitor of androgen biosynthesis introduced for mCRPC. The objective of this study is to compare costs and outcomes associated with the use of Abiraterone Acetate AA as add on therapy with prednisone versus prednisone alone in mCRPC patients who have progressed after chemotherapy.

METHODS

A cost utility model was adopted based on Survival data taken from COU-AA-301 study. The time horizon was 2.5 years, which is the estimated survival of these patients based on expert opinion. Acquisition cost of drugs was collected from Health Insurance Organization (HIO) perspective in Egypt. Utility values were captured from published studies of the same target population. Both Costs & QALYs were discounted at 3.5% annually. DSA and PSA were conducted.

RESULTS

In mCRPC patients, AA+prednisone resulted in higher QALY which is 0.9 compared to 0.78 of prednisone alone, at total cost of 151,597.29 EGP for AA+prednisone compared to 13,192.07 EGP for prednisone alone, these yielded an ICER of 1,206,737.98 EGP/QALY. The result was higher than the accepted willingness to pay (WTP) threshold of Egypt 3GDP/Capita which is equal to 86000EGP /QALY. The model was more sensitive to the cost of AA based on DSA results. PSA revealed that at WTP of 86000EGP per QALY, the probability of AA being not cost effective is 97.35%.

CONCLUSIONS :

Abiraterone Acetate in addition to prednisone revealed to be not cost effective treatment option compared to prednisone alone from (HIO) perspective in Egypt for mCRPC patients who have received chemotherapy