Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

  • Jaclyn Beca Cancer Care Ontario
  • Habeeb Majeed
  • Kelvin K.W. Chan
  • Sebastian J. Hotte
  • Andrew Loblaw
  • Jeffrey S. Hoch
Keywords: Prostate cancer, Cost-effectiveness analysis

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
2019-03-22
How to Cite
Beca, J., Majeed, H., Chan, K. K., Hotte, S. J., Loblaw, A., & Hoch, J. S. (2019). Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer. Canadian Urological Association Journal, 13(12). https://doi.org/10.5489/cuaj.5889
Section
Original Research