Abiraterone vs. docetaxel for metastatic hormone-sensitive prostate cancer: A microsimulation model

被引:7
作者
Hird, Amanda E. [1 ,2 ]
Magee, Diana E. [2 ,3 ]
Cheung, Douglas C. [2 ,3 ]
Matta, Rano [1 ,2 ]
Kulkarni, Girish S. [2 ,3 ]
Nam, Robert K. [1 ,2 ]
机构
[1] Sunnybrook Hlth Sci Ctr, Div Urol, Toronto, ON, Canada
[2] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[3] Univ Hlth Network, Princess Margaret Hosp, Div Urol, Toronto, ON, Canada
来源
CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL | 2020年 / 14卷 / 09期
关键词
QUALITY-OF-LIFE; ANDROGEN-DEPRIVATION THERAPY; COST-EFFECTIVENESS; OPEN-LABEL; TREATMENT PATTERNS; PHASE-III; CABAZITAXEL; ACETATE; ENZALUTAMIDE; MEN;
D O I
10.5489/cuaj.6234
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Our aim was to determine whether androgen deprivation therapy (ADT) with abiraterone acetate (AA) or ADT with docetaxel chemotherapy (DC) resulted in improved quality-adjusted life years (QALYs) among men with de novo metastatic castration-sensitive prostate cancer (mCSPC) and the cost effectiveness of the preferred strategy using decision analytic techniques. Methods: A microsimulation model with a lifetime time horizon was constructed. Our primary outcome was QALYs. Secondary outcomes included cost, incremental cost effectiveness ratio (ICER), unadjusted overall survival (OS), rates of second- and third-line therapy, and adverse events. A systematic literature review was used to generate probabilities and utilities to populate the model. The base case was a 65-year-old patient with de novo mCSPC. Results: A total of 100 000 microsimulations were generated. Initial AA resulted in a gain of 0.45 QALYs compared to DC (3.36 vs. 2.91 QALYs) with an ICER of $276 251.82 per QALY gained with initial AA therapy. Median crude OS was 51 months with AA and 48 months with DC. Overall, 46.6% and 42.6% of patients received second-line therapy and 8.7% and 7.9% patients received third-line therapy in the AA and DC groups, respectively. Grade 3/4 adverse events were experienced in 17.6% of patients receiving initial AA and 22.3% of patients receiving initial DC. Conclusions: Although ADT with AA results in a gain in QALYs and crude OS compared to DC, AA therapy is not a cost-effective treatment strategy to apply uniformly to all patients. The availability of AA as a generic medication may help to close this gap. The ultimate choice should be based on patient and tumor factors.
引用
收藏
页码:E418 / E427
页数:10
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