关键词:
Budget impact analysis
Cost-effectiveness analysis
Enzalutamide
Metastatic castration-resistant prostate cancer
Metastatic hormone-sensitive prostate cancer
摘要:
We conducted cost-effectiveness analysis and budget impact analysis for androgen deprivation therapy (ADT) plus enzalutamide (ENZ) on patients with metastatic hormone-sensitive prostate cancer (mHSPC) from the publicly-funded healthcare system perspective. Using a partitioned survival model, lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) of ADT + ENZ were estimated against ADT alone, ADT plus abiraterone (ADT + ABI), and ADT plus apalutamide (ADT + APA). Total healthcare cost differences with and without ENZ in mHSPC therapy were estimated for the period from 2022 to 2026. Based on cost-effectiveness analysis, the ICER ofADT + ENZ versus ADT alone was estimated as ¥7.18 million/QALY gained. ADT + ABI and ADT + APA were dominated options (extended dominance). Budget impact analysis showed that incorporation of ENZ had a net budget impact of ¥57.19 billion, an 8.4% increase, over these 5 years. This amounted to a budgetary impact of ¥ 16,000 per patient per month at year 5. However, the number of patients with disease progressed to metastatic castration-resistant prostate cancer (mGRPC) would be reduced from 79,000 (without ENZ) to 65,000 (with ENZ), resulting in a 17% cost reduction within the mCRPC phase. In conclusion, ADT + ENZ would be a cost-effective option, at the willingness to pay threshold of ¥7.5 million/QALY gained. Introduction of ENZ in the mHSPC treatment would result in a marginal increase in the total budget. However, ENZ is also expected to provide clinical benefits in reducing the number ofpatients with disease that would otherwise progress to mCRPC during these 5 years, resulting in cost savings in this phase. © 2023 Editorial Board of Acta Urologica Japonica. All rights reserved.