1. Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer
- Author
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Claudine de Meijer, Dirk Wyndaele, Walter Noordzij, Pieter van den Berg, Agni Baka, Annemarie M. Leliveld-Kors, Joan van den Bosch, Michel L. Peters, Jennifer G. Gaultney, and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE)
- Subjects
Radium-223 ,Oncology ,Economics and Econometrics ,medicine.medical_specialty ,ENZALUTAMIDE ,Cost effectiveness ,Urology ,COST-EFFECTIVENESS ANALYSIS ,DOUBLE-BLIND ,03 medical and health sciences ,chemistry.chemical_compound ,Prostate cancer ,0302 clinical medicine ,QUALITY-OF-LIFE ,Internal medicine ,medicine ,Enzalutamide ,health care economics and organizations ,BONE METASTASES ,business.industry ,030503 health policy & services ,Health Policy ,Abiraterone acetate ,General Medicine ,Cost-effectiveness analysis ,CHEMOTHERAPY ,medicine.disease ,RANDOMIZED-TRIAL ,ABIRATERONE ACETATE ,chemistry ,Docetaxel ,Cabazitaxel ,030220 oncology & carcinogenesis ,DOCETAXEL TREATMENT ,0305 other medical science ,business ,UTILITY ANALYSIS ,medicine.drug - Abstract
BACKGROUND: The treatment of metastatic castration-resistant prostate cancer has changed with the introduction of radium-223, cabazitaxel, abiraterone and enzalutamide. To assess value for money, their cost effectiveness in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective was investigated.METHODS: A cost-effectiveness analysis was conducted using efficacy, symptomatic skeletal-related event and safety data obtained from indirect treatment comparisons. Missing skeletal-related event data for cabazitaxel were conservatively assumed to be identical to radium-223. A Markov model combined these clinical inputs with Dutch-specific resource use and costs for metastatic castration-resistant prostate cancer treatment from a societal perspective. Total quality-adjusted life-years and costs in 2017 euros were calculated over a 5-year (lifetime) time horizon.RESULTS: Radium-223 resulted in €6092 and €4465 lower costs and 0.02 and 0.01 higher quality-adjusted life-years compared with abiraterone and cabazitaxel, respectively, demonstrating dominance of radium-223. Sensitivity analyses reveal a 64% (54%) chance of radium-223 being cost effective compared with abiraterone (cabazitaxel) at the informal €80,000 willingness-to-pay threshold. Compared with enzalutamide, radium-223 resulted in slightly lower quality-adjusted life-years (-0.06) and €7390 lower costs, revealing a 61% chance of radium-223 being cost effective compared with enzalutamide. The lower costs of radium-223 compared with abiraterone and enzalutamide are driven by lower drug costs and prevention of expensive skeletal-related events. Compared with cabazitaxel, the lower costs of radium-223 are driven by lower costs of the drug, administration and adverse events.CONCLUSION: Radium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective.
- Published
- 2017
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