Cost-effectiveness Analysis of Innovative Therapy for Patients with Newly Diagnosed Hormone-Sensitive Metastatic Prostate Cancer

This study aims to define optimal sequencing for patients moving from metastatic hormone-sensitive prostate cancer to metastatic castrate-resistant prostate cancer based on their cost and effectiveness through literature publications. The results add useful information to clinicians and patients facing treatment decisions in the real world. Background: The optimal therapeutic strategies for patients with metastatic hormone-sensitive prostate cancer (mHSPC) followed by metastatic castrate-resistant prostate cancer (mCRPC), in terms of cost and effectiveness, remains unknown. This study aims to compare the cost-effectiveness of various potential strategies, from the start of first-line treatment in mHSPC to the death of the patients. Methods: Two Markov decision-analysis models were developed, one for cohort A ``asymptomatic/mildly symptomatic patients in mCRPC'', and one for cohort B ``symptomatic patients in mCRPC''. Each strategy reflects daily practice for mHSPC until progression in mCRPC from the start of first treatment regimen with either docetaxel or abiraterone acetate plus prednisone (AA) in mHSPC to the death of the patient. The cost-effectiveness analysis was performed from the French public health care system perspective. Only direct medical costs were included. Survival data were extracted from results of published randomized clinical trials. Results: For cohort A, docetaxel followed by AA is the most cost-effective therapeutic strategy ( euro 96,925 for 4.24 life-years). For cohort B, docetaxel followed by docetaxel is the most cost-effective therapeutic strategy ( euro 81,463 for 4.05 life-years). Sensitivity analyses confirmed the robustness of our results except for a price reduction of 70% for AA or enzalutamide. Conclusion: Our approach is innovative to the extent that our analysis considers various potential strategies for metastatic prostate cancer (mPC). Our economic evaluation suggests that a price reduction of AA or enzalutamide impacts on the results. This approach must continue, including new drugs for patients with mPC.