Pharmacoeconomics of available treatment options for metastatic prostate cancer

A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer

INTRODUCTION

Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems.

AREAS COVERED

In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies.

EXPERT OPINION

The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.

Optimum Imaging Strategies for Advanced Prostate Cancer: ASCO Guideline

PURPOSE

Provide evidence- and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups.

METHODS

An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality.

RESULTS

A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles.

RECOMMENDATIONS

One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography [CT], bone scan, and/or prostate magnetic resonance imaging [MRI]) and/or next-generation imaging (NGI), positron emission tomography [PET], PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.

The economics of abiraterone acetate for castration-resistant prostate cancer

Abiraterone acetate is an oral medication that has recently been granted approval for the treatment of metastatic castration resistant prostate cancer (mCRPC) prior and/or after chemotherapy with docetaxel. In this article we assess the economics of abiraterone acetate in mCRPC. Relevant studies demonstrated that abiraterone acetate had a minimal budget impact on health plans. A relevant advantage was the cost savings due to the lack of chemotherapy-related side effects as well as the ease of administration. The results of cost/benefit comparative studies with other novel agents (i.e. cabazitaxel, enzalutamide, sipuleucel-T) are warranted as well as the close collaboration between urologists and medical oncologists.

Surgical castration for androgen-deprivation therapy of prostate cancer – relevance in current practice

Objective:

Rapid control of the disease is essential in the management of patients with critical and symptomatic metastatic prostate cancer. Pharmacological castration has become the main form of androgen-deprivation therapy (ADT) for prostate cancer, with luteinising hormone-releasing hormone (LHRH) agonists being used in more than 90% of cases. Surgical castration has become the less preferred modality. This article aims to explore the clinical and economic advantages of bilateral sub-capsular orchidectomy (BSCO).

Method:

Pre- and post-operative serial testosterone levels were taken from patients who had BSCO for adenocarcinoma of the prostate. The half-life of testosterone was calculated. The cost of surgical castration on the National Health Service (NHS) was compared to the cost of LHRH agonists.

Results:

Ten patients with a median prostate-specific antigen (PSA) level of 93 ng/ml (range 26 to 4557 ng/ml) were included. Their mean random pre-operative testosterone level was 13.8 ng/ml (range 6.8 to 21.8 ng/ml). The mean half-life of testosterone was 61.7 minutes when calculated from the first two hours, and 67 minutes when calculated from the total drop with no significant variation ( p = 0.464). Four patients reached castrate levels of testosterone within four to six hours. The total cost of an inpatient BSCO in the NHS was £850 to £1154. This was more or less equivalent to one year’s worth of the commonly used LHRH agonists without including the cost of medical services.

Conclusions:

Testosterone has a short half-life and reaches castrate levels within hours of the BSCO procedure. Rapid castration by BSCO would benefit patients with critical metastatic disease. BSCO on the NHS in patients with more than one year of life expectancy is also economically beneficial.