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| Cost-effectiveness analysis of treatments for metastatic castration resistant prostate cancer |
| Matthew E. Pollarda, Alan J. Moskowitzb, Michael A. Diefenbachc, Simon J. Hallc
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a Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA;
b Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY, USA;
c Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA |
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Abstract Objective: Treatment options for metastatic castration resistant prostate cancer (mCRPC) have expanded rapidly in recent years. Given the significant economic burden, we sought perform a cost-effectiveness analysis (CEA) of the contemporary treatment paradigm for mCRPC.Methods: We devised a treatment protocol consisting of sipuleucel-T, enzalutamide, abiraterone, docetaxel, radium-223, and cabazitaxel. We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials. We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA. Our analysis assumed US$100,000 per life year saved (LYS) as the threshold societal willingness to pay.Results: Incremental cost-effectiveness ratios (ICER) for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS, the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS. Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS..Conclusion: Based on the available survival data and current costs of treatment, all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS. Improvements in this regard can only come with a reduction in pricing, better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.
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Received: 23 September 2016
Published: 16 February 2017
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Corresponding Authors:
Simon J. Hall,E-mail address:Shall12@Northwell.edu
E-mail: Shall12@Northwell.edu
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