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. 2019 Mar 7;17(2):eGS4414.
doi: 10.31744/einstein_journal/2019GS4414.

Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer

[Article in English, Portuguese]
Pedro Nazareth Aguiar Jr  1   2 , Pui San Tan  3 , Sarah Simko  4 , Carmelia Maria Noia Barreto  5 , Bárbara de Souza Gutierres  6 , Auro Del Giglio  1 , Gilberto de Lima Lopes Jr  7
Affiliations

Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer

[Article in English, Portuguese]
Pedro Nazareth Aguiar Jr et al. Einstein (Sao Paulo). .

Abstract
in English, Portuguese

Objective: To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation.

Methods: We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects.

Results: Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively.

Conclusion: The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.

Objetivo: Avaliar a relação custo-efetividade da adição de quimioterapia ou abiraterona à terapia de privação hormonal.

Métodos: Um modelo analítico foi desenvolvido para determinar a relação custo-efetividade da adição de docetaxel ou abiraterona comparada à terapia de privação hormonal isolada. Custos diretos e indiretos foram incluídos no modelo. Os efeitos foram expressos em Anos de Vida Ajustados para Qualidade corrigidos pelos efeitos colaterais de cada terapia.

Resultados: A adição de quimioterapia e de abiraterona à terapia de privação hormonal aumentou os Anos de Vida Ajustados para Qualidade em 0,492 e 0,999, respectivamente, em comparação à terapia de privação hormonal isolada. A abiraterona promoveu ganho de Anos de Vida Ajustados para Qualidade de 0,506 em relação ao docetaxel. O custo incremental por Anos de Vida Ajustados para Qualidade foi R$ 133.649,22 para o docetaxel, R$ 330.828,70 para a abiraterona e R$ 571.379,42 para a abiraterona comparada ao docetaxel.

Conclusão: A adição de quimioterapia à terapia de privação hormonal é mais custo-efetiva que a adição de abiraterona à terapia de privação hormonal. Contudo, descontos no custo da abiraterona poderiam tornar esse tratamento mais custo-efetivo.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. Analytic model of decision
Figure 2
Figure 2. Survival estimates free of failure and overall survival. (A) Failure-free survival exponential estimative. (B) Overall survival exponential estimative
Figure 3
Figure 3. Tornado diagram for abiraterone plus androgen deprivation therapy or docetaxel plus androgen deprivation therapy versus androgen deprivation therapy alone
Figure 4
Figure 4. Tornado diagram for abiraterone plus androgen deprivation therapy versus docetaxel plus androgen deprivation therapy
Figure 5
Figure 5. Probability of being cost-effective
See this image and copyright information in PMC

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