Journal
BMC CANCER
Volume 21, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s12885-020-07754-9
Keywords
Cabazitaxel; Abiraterone; Enzalutamide; Docetaxel; Cost-effectiveness; Prostate cancer
Categories
Funding
- National Natural and Scientific Foundation of China [81572988]
- Science & Technology Department of Sichuan Province Funding Project [2016FZ0108, 2018SZ0117]
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From the US payer's perspective, cabazitaxel may not be a cost-effective treatment option compared to androgen-signaling-targeted inhibitors for patients with mCRPC who had progression within 12 months while receiving ASTIs after docetaxel treatment.
BackgroundThe aim of our study was to evaluate the cost-effectiveness of cabazitaxel versus abiraterone or enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel who had progression within 12months while receiving an alternative inhibitor (abiraterone or enzalutamide) from a US payer's perspective.MethodsTo conduct the cost-effectiveness analysis, a Markov decision model was established. Three health states (progression-free survival (PFS), progressive disease (PD) and death) were included, and the incremental cost-effectiveness ratio (ICER) was regarded as the primary endpoint. The willingness-to-pay (WTP) threshold was set at $100,000.00/quality-adjusted life year (QALY), and discounted rates were set at 3% annually. Efficacy data were derived from the CARD trial and Weibull distribution curves were modeled to fit the survival curves. The robustness of the analysis was tested with a series of one-way sensitivity analyses and probabilistic sensitivity analyses.ResultsOverall, the incremental effectiveness and cost of cabazitaxel versus androgen-signaling-targeted inhibitors (ASTIs) were 0.16 QALYs and $49,487.03, respectively, which yielded an ICER of $309,293.94/QALY. Our model was mostly sensitive to the duration of PFS in the cabazitaxel group, cost of cabazitaxel and utility of the PFS state. At a WTP threshold of $100,000.00/QALY, cabazitaxel was the dominant strategy in 0% of the simulations.ConclusionsCabazitaxel is unlikely to be a cost-effective treatment option compared with ASTIs in patients with mCRPC previously treated with docetaxel who had progression within 12months while receiving ASTIs.
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