Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor-targeted agents matter?. (7th February 2023)

• Record Type: Journal Article
• Authors: Pereira-Salgado, Amanda; Anton, Angelyn; Franchini, Fanny; Mahar, Robert K.; Kwan, Edmond M.; Wong, Shirley; Shapiro, Julia; Weickhardt, Andrew; Azad, Arun A.; Spain, Lavinia; Gunjur, Ashray; Torres, Javier; Parente, Phillip; Parnis, Francis; Goh, Jeffrey; Steer, Christopher; Brown, Stephen; Gibbs, Peter; Tran, Ben; IJzerman, Maarten
• Is Part Of: Expert review of pharmacoeconomics & outcomes research. Volume 23:Number 2(2023)
• Page Start: 231
• Page End: 239
• Publication Date: 2023-02-07
• Subjects: Health economics -- metastatic castration-resistant prostate cancer -- prostate cancer -- time-to-treatment failure -- treatment costs -- treatment sequences; Pharmacology -- Economic aspects -- Periodicals; 338.47615105
• DOI: 10.1080/14737167.2023.2161048
• Languages: English
• ISSNs: 1473-7167

Abstract

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.