OBJECTIVES: Enzalutamide (ENZA) and abiraterone acetate plus prednisone (ABI) are approved oral treatments for patients with metastatic castration-resistant prostate cancer (mCRPC) after progression on docetaxel in the Mexican public healthcare (PHC) system. Financial schemes have been proposed to facilitate access to these new treatment options. This analysis evaluated the cost-effectiveness of ENZA and ABI for patients with mCRPC progressing after docetaxel treatment in the Mexican PHC system.

METHODS: A three health-state Markov model was developed in which “free of progression”, “progression”, and “death” were defined as health states. Safety and efficacy inputs of ENZA and ABI were obtained from a published meta-analysis and the clinical trials AFFIRM (for ENZA) and COU-AA-301 (for ABI). Cost per month in each health state considered direct medical costs from local sources of the Mexican Social Security Institute (IMSS), and included the cost of treatment and adverse event management. A risk-sharing agreement was modeled, eliminating the cost of ENZA for patients with treatment failure before 12 months of treatment. A 3-year time horizon was utilized and a deterministic sensitivity analysis was performed to identify the most relevant variables.

RESULTS: For the base-case scenario, the results showed a 0.21-year increase in overall survival in favor of ENZA and an incremental cost of MX$3435. This represents an incremental cost-effectiveness ratio (MX$/life-year gained) of MX$16,197, which is considered cost-effective at the willingness-to-pay threshold of MX$167,583. The sensitivity analysis showed that the cost of drugs and length of the risk-sharing agreement were the most relevant variables.

CONCLUSIONS: From the IMSS perspective in Mexico, ENZA is a cost-effective alternative treatment for patients with mCRPC after progression on docetaxel. The introduction of financial schemes to purchase innovative technologies seems a highly promising method of improving access to modern and more effective drugs for cancer patients in the Mexican PHC system.