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.
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