OBJECTIVES: Radium-223 (²²³Ra) dichloride has been used to treat mCRPC since 2013. In 2022, lutetium-177 vipivotide tetraxetan (¹⁷⁷Lu-PSMA-617) also gained approval for mCRPC, initially in the United States (US). This study aims to compare the diagnostic, administration, and treatment costs of ²²³Ra dichloride versus ¹⁷⁷Lu-PSMA-617 therapy for mCRPC patients from a third-party payer perspective in the US, Japan, Germany, France, and UK.

METHODS: A model was developed in accordance with treatment guidelines for mCRPC patient candidates of either targeted alpha therapy, ²²³Ra dichloride, or beta-emitting therapy, ¹⁷⁷Lu-PSMA-617. It includes all diagnostic, administration, treatment, and monitoring steps stratified by setting of care, whether in- or out-patient, and accounts for variations in diagnostic and therapeutic approaches known to date. Coding, coverage, and reimbursement pathways were established by funding archetype (fee-for-service plus cost, diagnosis-related group (DRG)-based lump sum, etc.). The model does not consider potential differences of treatment effects between the therapies.

RESULTS: Across all countries, likely therapeutic approaches, and care settings, treating mCRPC patients with ²²³Ra dichloride is less costly than with ¹⁷⁷Lu-PSMA-617 from a third-party payer perspective. The primary driver of the difference is the cost of ¹⁷⁷Lu-PSMA-617, along with setting of care and funding system as a modulator. Under fee-for-service, incremental diagnostic costs to qualify for ¹⁷⁷Lu-PSMA-617 and monitoring costs for treatment effect widen the difference. In DRG-based (inpatient) funding systems, the cost difference is moderated by procedure costs already being included in lump sum payments.

CONCLUSIONS: This detailed treatment reimbursement analysis, agnostic of treatment effect, shows that ²²³Ra dichloride is less costly than ¹⁷⁷Lu-PSMA-617 from a third-party payer perspective. This may be an important consideration in addition to therapeutic benefit for the respective modalities and respective (pending) indications. The model can be further refined to account for any differences in therapeutic benefit between the two modalities.