A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer

ABSTRACT

Introduction

Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems.

Areas covered

In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies.

Expert opinion

The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.

KEYWORDS:

• Prostate cancer
• docetaxel
• cabazitaxel
• enzalutamide
• abiraterone
• castration-resistant
• pharmacoeconomics
• cost-effectiveness
• safety profile

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Prostate cancer, especially when progressing to metastatic, castration-resistant stages, is a costly disease for healthcare systems

• Docetaxel seems to be a cost-effective option for managing patients with advanced prostate cancer

• Enzalutamide comprises a more expensive drug compared to abiraterone, but with reduced expenditures on monitoring, side-effects and inpatient or outpatient visits and hospital admissions

• Testing for AR-V7 mutation before initiating treatment with abiraterone or enzalutamide could result in substantial cost savings for healthcare systems

• Direct comparisons between therapeutic option are needed to draw safer conclusions

Abbreviation list

PCa= prostate cancer

CRPC= castration-resistant prostate cancer

ADT= androgen deprivation therapy

OS= overall survival

mCRPC= metastatic castration-resistant prostate cancer

CUA= cost-utility analysis

CEA= cost-effectiveness analysis

CBA= cost-benefit analysis

QALYs= quality-adjusted life years

LYs= life years

ICER= incremental cost-effectiveness ratio

hsPCa= hormone-sensitive prostate cancer

LHRH= luteinizing hormone-releasing hormone

GDPpc= gross domestic product per capita

SREs= skeletal related events

RANK-L= receptor activator of nuclear factor kappa-B

nmCRPC=non-metastatic castration-resistant prostate cancer

AR= androgen receptor

MFS= metastasis-free survival

Additional information

Funding

This manuscript is not funded.