Velasco-Roces L, Rubio T

Language: Spanish
References: 28
Page: 26-35
PDF size: 323.64 Kb.

ABSTRACT

Background: Prostate cancer is the most frequent tumor in men, followed by lung cancer. Pharmacologic treatment in patients with metastatic prostate cancer is palliative and its goal is to increase survival and quality of life. Between 10 and 20% of the patients will develop castration resistance within the first five years. It is recommended in all cases to maintain hormonal blockade associated with a new hormonal maneuver (androgen administration or withdrawal, extratesticular androgen synthesis, etc.) or others, such as chemotherapy.
Objective: To carry out a cost-utility analysis in Spain of the different existing alternatives for the treatment of metastatic castration-resistant prostate cancer in patients with disease progression after a regimen of chemotherapy based on docetaxel.
Materials and Methods: The incremental cost-effectiveness ratio of the different drugs was expressed as euros for qualityadjusted life years in metastatic castration-resistant prostate cancer. For the quality-adjusted life year estimate, only the direct costs were taken into account and the health utilities were retrieved from the literature and obtained through indirect estimates. The perspective of the payer was considered, along with a temporary horizon of 18 months, and the inflation rate in Spain corresponding to costs published up to 2014.
Results: Cabazitaxel and abiraterone were the most effective treatments, as well as the most expensive. Using mitoxantrone as the reference, the incremental cost-utility of docetaxel, abiraterone, enzalutamide, and cabazitaxel was –3,581, 41,720, 98,845, and 118,788 euros per quality-adjusted life year, respectively. Docetaxel was dominant in relation to mitoxantrone, the drug used as the reference in our study.
Conclusions: Based on our model, abiraterone is a cost-effective treatment in patients with metastatic castration-resistant prostate cancer, whereas enzalutamide and cabazitaxel are not.

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