Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor-targeted agents matter?

ABSTRACT

Introduction

Health economic outcomes of real-world treatment sequencing of androgen receptor-targeted agents (ARTA) and docetaxel (DOC) remain unclear.

Material and Methods

Data from the electronic Castration-resistant Prostate cancer Australian Database (ePAD) were analyzed including median overall survival (mOS) and median time-to-treatment failure (mTTF). Mean total costs (mTC) and incremental cost-effectiveness ratios (ICER) of treatment sequences were estimated using the average sample method and Zhao and Tian estimator.

Results

Of 752 men, 441 received ARTA, 194 DOC, and 175 both sequentially. Of participants treated with both, first-line DOC followed by ARTA was the more common sequence (n = 125, 71%). mOS for first-line ARTA was 8.38 years (95% CI: 3.48, not-estimated) vs. 3.29 years (95% CI: 2.92, 4.02) for DOC. mTTF was 15.7 months (95% CI: 14.2, 23.7) for the ARTA-DOC sequence and 18.2 months (95% CI: 16.2, 23.2) for DOC-ARTA. In first-line, ARTA cost an additional $13,244 per mTTF month compared to DOC. In second-line, ARTA cost $6726 per mTTF month. The DOC-ARTA sequence saved $2139 per mTTF compared to ARTA-DOC, though not statistically significant.

Conclusion

ICERs show ARTA had improved clinical benefit compared to DOC but at higher cost. There were no significant cost differences between combined sequences.

KEYWORDS:

• Health economics
• metastatic castration-resistant prostate cancer
• prostate cancer
• time-to-treatment failure
• treatment costs
• treatment sequences

Author contributions

Concept and design: A Pereira-Salgado, A Anton, B Tran, R Mahar, M IJzerman. Acquisition of data: A Pereira-Salgado, A Anton, B Tran, R Mahar, M IJzerman. Analysis of data: A Pereira-Salgado, F Franchini. Verification and interpretation of data analysis: A Pereira-Salgado, A Anton, F Franchini, B Tran, R Mahar, M IJzerman. Critical revision of the manuscript for important intellectual content: A Pereira-Salgado, A Anton, F Franchini, R Mahar, B Tran, M IJzerman. All authors read and approved the final version of the manuscript for publication.

Declaration of interests

A Anton declares: honoraria: Amgen, Janssen; Research Funding (institutional): Mundipharma, Astellas, Amgen, AstraZeneca, Janssen. A. Azad declares: Speakers Bureau – Astellas, Janssen, Novartis, Amgen, Ipsen, Bristol Myers Squibb; Merck Serono, Bayer. Honoraria – Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Telix; Merck Serono; Janssen, Bristol Myers Squibb, Ipsen, Bayer, Pfizer, Amgen, Noxopharm, Merck Sharpe Dome, Aculeus Therapeutics. Scientific Advisory Board – Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Pfizer, Telix; Merck Serono; Janssen, Bristol Myers Squibb, Ipsen, Bayer, Merck Sharpe Dome, Amgen, Noxopharm. Travel + Accommodation – Astellas, Merck Serono, Amgen, Novartis, Janssen, Tolmar, Pfizer. Research Funding – Astellas (investigator), Merck Serono (investigator), Astra Zeneca (investigator), Bristol Myers Squibb (institutional), Astra Zeneca (institutional), Aptevo Therapeutics (institutional), Glaxo Smith Kline (institutional), Pfizer (institutional), MedImmune (institutional), Astellas (institutional), SYNthorx (institutional), Bionomics (institutional), Sanofi Aventis (institutional), Novartis (institutional), Ipsen (institutional), Exelixis (institutional), Merck Sharpe Dome (institutional), Janssen (institutional). F Parnis declares: Stock ownership – Telix Pharmaceuticals. Advisory Board – Janssen, Ipsen, Merck Serono, Amgen. P Gibbs declares: Research Funding (institutional): Astellas, Amgen, AstraZeneca, Janssen. B Tran declares: Grants and personal fees – Amgen, AstraZeneca, BMS, Janssen, Pfizer, MSD, Ipsen, Bayer; grants from Astellas, Personal fees – IQVIA, Roche, Sanofi, Tolmar, and Novartis. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2161048

Additional information

Funding

This research project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector. The ePAD clinical registry received financial support from Amgen, AstraZeneca, Astellas, and Janssen during the period of this study. These pharmaceutical companies were not involved in the study design, data analysis, or production of this manuscript.