Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients

Jan 1, 2021, 00:00
10.1016/j.jval.2020.04.1838
https://www.valueinhealthjournal.com/article/S1098-3015(20)32211-7/fulltext
Title : Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)32211-7&doi=10.1016/j.jval.2020.04.1838
First page : 121
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 121

Objectives

Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (C ) of abiraterone. Patients with a plasma C below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone C in patients with mCRPC.

Methods

A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone C followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate C taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER).

Results

Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively.

Conclusions

Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Oncology
  • Reproductive & Sexual Health
  • Specific Diseases & Conditions
Tags :
  • abiraterone
  • cost-effectiveness
  • food
  • prostate cancer
  • therapeutic drug monitoring
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