OBJECTIVES:

To estimate the cost-effectiveness and budget impact of enzalutamide treatment in patients with high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) from the Mexican healthcare perspective.

METHODS:

A cost-effectiveness analysis (CEA) and budget impact analysis (BIA) were performed to compare apalutamide with enzalutamide for the treatment of patients with high-risk nmCRPC. The estimates of the target population were calculated based on the total number of adult (≥18 years) males in Mexico and patient segmentation (incidence of prostate cancer, percentage of patients with CRPC, non-metastatic status, high-risk status, and insurance status within the Mexican public system). The costs were extracted from the published databases of the Mexican healthcare system and included monthly drug costs, medical costs (androgen deprivation therapy [ADT], monitoring, office/inpatient visits), and cost associated with adverse event management. CEA was performed using a Markov model and effectiveness was measured as life years gained (LYG). BIA estimated the differences in total cost between the current reimbursed scenario (ADT + apalutamide) and future scenario (inclusion of ADT + enzalutamide) over a 5-year time horizon without discounting. All costs are expressed in United States dollars (USD).

RESULTS:

The estimated target population included in the analyses over a 5-year time horizon ranged from 353 to 370 patients. CEA estimated that treatment with enzalutamide reduced total cost by USD 4,309 and the difference in LYG was 0.04 compared to apalutamide. The incremental cost-effectiveness ratio revealed that enzalutamide was the dominant treatment. A comparison of the current and future scenario in the BIA estimated an average 5-year reduction of cost by USD 200,164 in the future scenario.

CONCLUSIONS:

Enzalutamide is a cost-effective treatment option for patients with high-risk nmCRPC and can provide potential savings for the Mexican healthcare system.