OBJECTIVES: To assess the health and economic impact of adding enzalutamide to the Mexican healthcare system versus apalutamide for nmCRPC with high risk of progression.

METHODS: A semi-Markov model was built to assess the cost utility of enzalutamide + androgen deprivation therapy (ADT) versus apalutamide + ADT and ADT monotherapy in the Mexican 2018 public payer setting. The model was designed using three health states (nmCRPC; metastatic disease; death) with 1-month cycles and a time horizon of 20 years to represent complete disease history. A 5% discount was applied to costs and outcomes; metastasis-free survival was based on enzalutamide and apalutamide clinical trials. Resource use was estimated from interviews with six top oncologists; costs for drugs, adverse events, laboratory tests, and doctors’ visits were obtained from Mexican Institute of Social Security’s Diagnostic-Related Groups and unitary costs. Apalutamide cost was assumed as the average of prices in Brazil and the United States, where approved. A budget impact model with a 5-year time horizon was developed to assess the financial impact of adding enzalutamide for the nmCRPC population. Sensitivity analyses were run to assess the robustness of this appraisal. Results are presented in 2018 Mexican pesos.

RESULTS: Total costs were MXN$1.2M for enzalutamide + ADT, MXN$1.45M for apalutamide + ADT, and MXN$11,710 for ADT alone. Enzalutamide was associated with better QALYs than apalutamide + ADT (3.75, 3.27, and 3.00, respectively). Enzalutamide dominated apalutamide and had an ICER of MXN$1.5M versus ADT. Average budget impact of enzalutamide per patient per year was MXN$42,025. Total budget impact in 5 years was MXN$500,231,902, representing 0.434% of the 2018 public budget.

CONCLUSIONS: Enzalutamide represents a cost-effective alternative for the Mexican public healthcare system versus apalutamide for the treatment of nmCRPC, while also representing a low budget impact.

FUNDING: Astellas Pharma Inc. and Medivation LLC, a Pfizer Company

EDITORIAL: Complete HealthVizion