COST-EFFECTIVENESS ANALYSIS OF ENZALUTAMIDE FOR PATIENTS WITH CHEMOTHERAPY-NAÏVE METASTATIC CASTRATION-RESISTANT PROSTATE CANCER IN JAPAN
Author(s)
Okumura H1, Inoue S2, Naidoo S3, Holmstrom S4, Akaza H5, Duran A6
1Astellas, Medical Affairs, Tokyo, Japan, 2CRECON Medical Assessment Inc., Tokyo, Japan, 3Astellas Pharma Europe, Ltd, Chertsey, UK, 4Astellas Medical Affairs Global, Leiden, The Netherlands, 5The University of Tokyo, Tokyo, Japan, 6Astellas Pharma Europe Ltd, Chertsey, UK
OBJECTIVES: To evaluate the cost-effectiveness of enzalutamide in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients in the Japanese healthcare setting. METHODS: A Markov model was developed to capture time spent by patients in various health states: stable, progression, and death. Abiraterone acetate plus prednisone and docetaxel were set as active comparators. Clinical outcomes were obtained from the PREVAIL, COU-AA-302, and TAX327 trials. Treatment sequence, concomitant drugs in each treatment regimen, and therapies for both palliative care and adverse events were estimated from responses to a survey for medical resource consumption by 14 prostate cancer experts. Analytic perspective was public healthcare payer and the time horizon was 10 years. Incremental cost-effectiveness ratio (ICER) was estimated from quality-adjusted life years (QALY) and Japanese public healthcare costs. Both costs and outcomes were discounted by 2%. Probabilistic sensitivity analysis was performed to assess the robustness of the findings. RESULTS: According to the survey, the most common treatment sequences (first→second→third) were as follows: 1) enzalutamide→docetaxel→cabazitaxel, 2) abiraterone→enzalutamide→docetaxel, 3) docetaxel→enzalutamide→cabazitaxel. The following sequence was included in a scenario analysis as an alternative sequence of 1: 4) enzalutamide→abiraterone→docetaxel. In the base-case analysis, sequence 1 saved JPY 1.74 million compared with sequence 2, with a 0.129 utility gain (dominant). Sequence 1 had a cost increase of JPY 4.44 million over sequence 3, with a 0.371 utility gain. The ICER of sequence 1 versus sequence 3 was estimated as JPY 11.95 million/QALY gained. Similar results were obtained by the replacement of sequence 1 with sequence 4. Probabilistic sensitivity analysis demonstrated that, compared with sequence 2, the probability of sequence 1 being dominant was 87.4%. CONCLUSIONS: The results modeled in the present study suggest that the enzalutamide-first sequencing (1 and 4) is more cost-effective than the abiraterone-first sequencing, but less cost-effective than the docetaxel-first sequencing, for chemotherapy-naïve patients with mCRPC.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PCN114
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology