The effectiveness of the addition of docetaxel and/or zoledronic acid to the standard of care (SOC) for hormone-naive prostate cancer has been evaluated in the STAMPEDE trial. The object of the present analysis was to evaluate the cost-effectiveness of these treatment options in the treatment of advanced hormone-naive prostate cancer in China.
Methods
A cost-effectiveness analysis using a Markov model was carried out from the Chinese societal perspective. The efficacy data were obtained from the STAMPEDE trial and health utilities were derived from previous studies. Transition probabilities were calculated based on the survival in each group. The primary endpoint in the analysis was the incremental cost-effectiveness ratio (ICER), and model uncertainties were explored by 1-way sensitivity analysis and probabilistic sensitivity analysis.
Results
SOC alone generated an effectiveness of 2.65 quality-adjusted life years (QALYs) at a lifetime cost of $20,969.23. At a cost of $25,001.34, SOC plus zoledronic acid was associated with 2.69 QALYs, resulting in an ICER of $100,802.75/QALY compared with SOC alone. SOC plus docetaxel gained an effectiveness of 2.85 QALYs at a cost of $28,764.66, while the effectiveness and cost data in the SOC plus zoledronic acid/docetaxel group were 2.78 QALYs and $32,640.95.
Conclusions
Based on the results of the analysis, SOC plus zoledronic acid, SOC plus docetaxel, and SOC plus zoledronic acid/docetaxel are unlikely to be cost-effective options in patients with advanced hormone-naive prostate cancer compared with SOC alone.
TorreL.A., BrayF., SiegelR.L., FerlayJ., Lortet-TieulentJ., JemalA.Global cancer statistics, 2012. CA Cancer J Clin.2015; 65(2): 87–108.
2.
SharifiN., GulleyJ.L., DahutW.L.An update on androgen deprivation therapy for prostate cancer. Endocr Relat Cancer.2010; 17(4): R305–R315.
3.
WidmarkA., KleppO., SolbergA.; Scandinavian Prostate Cancer Group Study 7; Swedish Association for Urological Oncology 3. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet.2009; 373(9660): 301–308.
4.
WardeP., MasonM., DingK.; NCIC CTG PR.3/MRC UK PR07 investigators. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet.2011; 378(9809): 2104–2111.
5.
KuyuH., LeeW.R., BareR., HallM.C., TortiF.M.Recent advances in the treatment of prostate cancer. Ann Oncol.1999; 10(8): 891–898.
ScherH.I., KellyW.K.Flutamide withdrawal syndrome: its impact on clinical trials in hormone-refractory prostate cancer. J Clin Oncol.1993; 11(8): 1566–1572.
8.
SaadF., ColombelM.Management of castration-resistant prostate cancer: bisphosphonates and emerging therapies. Expert Rev Anticancer Ther.2010; 10(12): 1991–2002.
9.
SartorO., HalsteadM., KatzL.Improving outcomes with recent advances in chemotherapy for castrate-resistant prostate cancer. Clin Genitourin Cancer.2010; 8(1): 23–28.
10.
KantoffP.W., HiganoC.S., ShoreN.D.; IMPACT Study Investigators. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med.2010; 363(5): 411–422.
11.
JamesN.D., SydesM.R., MasonM.D.; STAMPEDE investigators. Celecoxib plus hormone therapy versus hormone therapy alone for hormone-sensitive prostate cancer: first results from the STAMPEDE multiarm, multistage, randomised controlled trial. Lancet Oncol.2012; 13(5): 549–558.
12.
JamesN.D., SydesM.R., ClarkeN.W.; STAMPEDE investigators. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet.2016; 387(10024): 1163–1177.
13.
Kellokumpu-LehtinenP.L., HarmenbergU., JoensuuT.; PROSTY study group. 2-Weekly versus 3-weekly docetaxel to treat castration-resistant advanced prostate cancer: a randomised, phase 3 trial. Lancet Oncol.2013; 14(2): 117–124.
14.
de BonoJ.S., OudardS., OzgurogluM.; TROPIC Investigators. 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.
15.
FizaziK., ScherH.I., MolinaA.; COU-AA-301 Investigators. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol.2012; 13(10): 983–992.
16.
RyanC.J., SmithM.R., de BonoJ.S.; COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med.2013; 368(2): 138–148.
17.
ScherH.I., FizaziK., SaadF.; AFFIRM Investigators. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med.2012; 367(13): 1187–1197.
18.
HoskinP., SartorO., OSullivanJ.M.Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: a prespecified subgroup analysis from the randomised, double-blind, phase 3 ALSYMPCA trial. Lancet Oncol.2014; 15(12): 1397–1406.
19.
WuB., LiT., CaiJ., XuY., ZhaoG.Cost-effectiveness analysis of adjuvant chemotherapies in patients presenting with gastric cancer after D2 gastrectomy. BMC Cancer.2014; 14(1): 984.
20.
PurmonenT., MartikainenJ.A., SoiniE.J., KatajaV., VuorinenR.L., Kellokumpu-LehtinenP.L.Economic evaluation of sunitinib malate in second-line treatment of metastatic renal cell carcinoma in Finland. Clin Ther.2008; 30(2): 382–392.
21.
NgR., HasanB., MittmannN.; Working Group on Economic Analysis; Lung Disease Site Group; National Cancer Institute of Canada Clinical Trials Group. Economic analysis of NCIC CTG JBR.10: a randomized trial of adjuvant vinorelbine plus cisplatin compared with observation in early stage non-small-cell lung cancera report of the Working Group on Economic Analysis, and the Lung Disease Site Group, National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol.2007; 25(16): 2256–2261.
22.
LuL., PetersJ., RoomeC., SteinK.Cost-effectiveness analysis of degarelix for advanced hormone-dependent prostate cancer. BJU Int.2012; 109(8): 1183–1192.
23.
MurrayC.J., EvansD.B., AcharyaA., BaltussenR.M.Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ.2000; 9(3): 235–251.
24.
SweeneyC.J., ChenY.H., CarducciM.Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med.2015; 373(8): 737–746.
25.
GravisG., FizaziK., JolyF.Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol.2013; 14(2): 149–158.
26.
TucciM., BertagliaV., VignaniF.Addition of docetaxel to androgen deprivation therapy for patients with hormone-sensitive metastatic prostate cancer: a systematic review and meta-analysis. Eur Urol.2016; 69(4): 563–573.
27.
ValeC.L., BurdettS., RydzewskaL.H.; STOpCaP Steering Group. Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data. Lancet Oncol.2016; 17(2): 243–256.
28.
MeropolN.J., SchulmanK.A.Cost of cancer care: issues and implications. J Clin Oncol.2007; 25(2): 180–186.
29.
ZhengH.R., WenF., WuY.F., WheelerJ.R., LiQ.Cost-effectiveness analysis of additional docetaxel for metastatic hormone-sensitive prostate cancer treated with androgen-deprivation therapy from a Chinese perspective. Eur J Cancer Care (Engl).2016 May 3. [Epub ahead of print].
