1. Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer
- Author
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Kelvin K. W. Chan, Jeffrey S Hoch, Jaclyn Beca, Habeeb Majeed, Andrew Loblaw, and S.J. Hotte
- Subjects
Urologic Diseases ,Oncology ,Comparative Effectiveness Research ,medicine.medical_specialty ,Base case analysis ,Cost effectiveness ,Urology ,medicine.medical_treatment ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Oncology and Carcinogenesis ,Disease ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Clinical Research ,Internal medicine ,medicine ,030212 general & internal medicine ,Cancer ,Original Research ,Chemotherapy ,business.industry ,Prostate Cancer ,Evaluation of treatments and therapeutic interventions ,Cost-effectiveness analysis ,Urology & Nephrology ,medicine.disease ,Hormone-sensitive ,Good Health and Well Being ,Cost Effectiveness Research ,Docetaxel ,6.1 Pharmaceuticals ,030220 oncology & carcinogenesis ,business ,medicine.drug - Abstract
Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.
- Published
- 2019