BACKGROUND: Abiraterone is a drug used for treating metastatic hormone sensitive prostate cancer (mHSPC). The combination of Abiraterone Acetate plus Prednisone (AAP) with the standard Androgen Deprivation Therapy (ADT) showed a better clinical outcome. Abiraterone received a negative recommendation from the National Institute for Health and Care Excellence (NICE) in 2021 due to its high cost. The cost of Abiraterone is expected to decrease after the brand's patent expires in September 2022 and this is anticipated to affect NICE’s decision.

OBJECTIVES: To assess the cost-effectiveness of Abiraterone using a cost utility analysis (CUA) that provides a potential new price of the generic version of Abiraterone that would make it cost effective.

METHODS: A partitioned survival model was constructed to compare the cost-effectiveness of AAP + ADT vs. ADT alone over a lifetime horizon from the perspective of the UK National Health Service (NHS). Costs and outcomes were measured over a lifetime horizon. The potential price was estimated based on a targeted literature review that was conducted to determine the patterns of price decreases following patent expiration.

RESULTS: The incremental cost-effective ratio (ICER) was £23,580 /QALY gained. AAP+ADT is 86% likely to be cost-effective at the threshold of £30,000 per quality-adjusted life-year (QALY). Cost-effectiveness estimates were most sensitive to the estimated discount for the potential generic version.

CONCLUSIONS: AAP + ADT is likely to be cost-effective for newly diagnosed mHSPC patients when a discount rate of 78.5% is applied to the current brand version price. This analysis sheds light on an opportunity for a cost-effective treatment that will improve management strategies for patients with prostate cancer.