Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 14;22(1):916.
doi: 10.1186/s12913-022-08274-x.

An economic evaluation of cabazitaxel versus a second androgen receptor-targeted agent (ARTA) for patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and an ARTA: the United States payer perspective

Alicia K Morgans  1 , Thomas Hutson  2 , Alice Kai Dan Guan  3 , David Garcia  4 , Anna Zhou  3 , Edward Drea  5 , Nicholas J Vogelzang  6
Affiliations

An economic evaluation of cabazitaxel versus a second androgen receptor-targeted agent (ARTA) for patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and an ARTA: the United States payer perspective

Alicia K Morgans et al. BMC Health Serv Res. .

Abstract

Background: Cabazitaxel significantly improves clinical outcomes compared with a second androgen receptor-targeted agent (ARTA) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and an ARTA (abiraterone or enzalutamide), as demonstrated in the CARD trial (NCT02485691). We aimed to estimate healthcare costs avoided with the use of cabazitaxel as a third-line (3 L) treatment versus a second ARTA from a US payer perspective.

Methods: Model inputs were based on the CARD trial, published sources, and estimates of typical clinical care patterns by genitourinary oncologists (n = 3). Assessed time points were 6, 12, 18, and 24 months. Outcomes included progression-free survival (PFS), radiographic PFS (rPFS), and overall survival (OS); hospitalization and intensive care unit (ICU) days; and costs (reported in 2020 US dollar [USD] and converted into Euro) to manage symptomatic skeletal events (SSEs), adverse events (AEs), and end-of-life care.

Results: At 18 months, in a cohort of 100 patients, the use of cabazitaxel was estimated to result in 9 more patients achieving rPFS, 2 more patients achieving PFS, and 17 more survivors versus a second ARTA. The costs of SSEs, AEs, and end-of-life care were $498,909 (€424,073), $276,198 (€234,768), and $808,785 (€687,468), respectively, for cabazitaxel and $627,569 (€533,434), $251,124 (€213,455), and $1,028,294 (€874,050), respectively, for a second ARTA. Cabazitaxel was estimated to be associated with a 21% reduction in both SSE management and end-of-life care costs. Hospitalization cost was $1,442,870 (€1,226,440) for cabazitaxel and $1,728,394 (€1,469,135) for a second ARTA, representing an estimated 17% reduction in these costs. Cabazitaxel, as compared with a second ARTA, was associated with 58 fewer hospitalization days and 2 fewer ICU days and was estimated to avoid $323,095 (€274,630, 17%) in total costs, driven by SSEs management and end-of-life care.

Conclusion: The use of cabazitaxel as a 3 L treatment after docetaxel and an ARTA in patients with mCRPC is estimated to result in clinical benefits (longer rPFS, PFS, and OS) and lower healthcare resource utilization (fewer hospitalization and ICU days), compared with a second ARTA.

Keywords: Androgen receptor-targeted agent; Cabazitaxel; Economic impact; End-of-life care; Metastatic castration-resistant prostate cancer; Symptomatic skeletal events; Third-line treatment.

PubMed Disclaimer

Conflict of interest statement

AKM reported receiving honoraria and advisory fees from Genentech, AstraZeneca, Sanofi, Bayer, Astellas Pharma, Janssen, Advanced Accelerator Applications, Myovant Sciences, and Exelixis; advisory fees from Blue Earth Diagnostics; honoraria from Astellas Scientific and Medical Affairs Inc., Janssen Oncology, Clovis Oncology, and Pfizer; grant support from Astellas Scientific and Medical Affairs Inc., Bayer, Seattle Genetics/Astellas, Genentech, and AstraZeneca; and travel support from Sanofi. TH reports receiving honoraria, advisory fees, grant support, and fees for serving on a speaker’s bureau from Pfizer, Johnson & Johnson, Bristol-Myers Squibb, Eisai, and Exelixis; honoraria, advisory fees, and fees for serving on a speakers bureau from Astellas Pharma; and honoraria and advisory fees from Novartis and Bayer/Onyx. AKG reported being employed by EVERSANA and holding stock in Tyme Technologies and Area Biopharma. DG and AZ reported being employed by EVERSANA. ED reported being employed by and holding stock in Sanofi. NJV reported being employed by and receiving travel and grant support from US Oncology; advisory fees, travel support, and fees for serving on a speakers bureau from Bayer, Genentech/Roche, and AstraZeneca; advisory fees and fees for serving on a speakers bureau from Clovis Oncology and Myovant Sciences; advisory fees, travel support, and honoraria from Pfizer; honoraria and fees for serving as an expert testimony from Novartis; advisory fees, grant support, and honoraria from Merck; travel support and fees for serving on a speakers bureau from Sanofi; advisory fees and holding stock in Caris Life Sciences; advisory fees from Tolero Pharmaceuticals, Astellas Pharma, Boehringer Ingelheim, Corvus Pharmaceuticals, Modra Pharmaceuticals, Janssen Oncology, and Eisai; fees for serving on a speakers bureau from Bristol-Myers Squibb, Seattle Genetics/Astellas. and AVEO; travel support from Exelixis; honoraria from UpToDateand; grant support from Endocyte and Suzhou Kintor Pharmaceuticals. No other potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Number of patients in rPFS, PFS, and OS at 18 months. ARTA, androgen receptor-targeted agent; OS, overall survival; PFS, progression-free survival; rPFS, radiographic progression-free survival. The number correspond to a cohort of 100 patients for each treatment
Fig. 2
Fig. 2
Hospitalization days (A) and ICU days (B) at 18 months. ARTA, androgen receptor-targeted agent; ICU, intensive care unit. The number correspond to a cohort of 100 patients for each treatment
Fig. 3
Fig. 3
Healthcare resource utilization costs at 18 months. ARTA, androgen receptor-targeted agent. The number correspond to a cohort of 100 patients for each treatment
Fig. 4
Fig. 4
Hospitalization and overall HCRU costs at 18 months. ARTA, androgen receptor-targeted agent; HCRU, healthcare resource utilization. The number correspond to a cohort of 100 patients for each treatment
See this image and copyright information in PMC

References

    1. American Cancer Society: Cancer facts & figures 2020. Estimated number of new cancer cases and deaths by sex, US, 2020.[https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-...].
    1. Tamada S, Iguchi T, Kato M, Asakawa J, Kita K, Yasuda S, Yamasaki T, Matsuoka Y, Yamaguchi K, Matsumura K, et al. Time to progression to castration-resistant prostate cancer after commencing combined androgen blockade for advanced hormone-sensitive prostate cancer. Oncotarget. 2018;9(97):36966–36974. doi: 10.18632/oncotarget.26426. - DOI - PMC - PubMed
    1. de Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels JP, Kocak I, Gravis G, Bodrogi I, Mackenzie MJ, Shen L, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010;376(9747):1147–1154. doi: 10.1016/S0140-6736(10)61389-X. - DOI - PubMed
    1. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, Oudard S, Theodore C, James ND, Turesson I, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351(15):1502–1512. doi: 10.1056/NEJMoa040720. - DOI - PubMed
    1. Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF, Redfern CH, Ferrari AC, Dreicer R, Sims RB, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med. 2010;363(5):411–422. doi: 10.1056/NEJMoa1001294. - DOI - PubMed

MeSH terms

LinkOut - more resources