Cost-Effectiveness Analysis of Systemic Therapy for Intensification of Treatment in Metastatic Hormone-Sensitive Prostate Cancer in India.

IF 3.1 4区医学 Q1 ECONOMICS

Applied Health Economics and Health Policy Pub Date : 2024-05-01 Epub Date: 2024-01-10 DOI:10.1007/s40258-023-00866-w

Nidhi Gupta, Dharna Gupta, Kiran Gopal Vaska, Shankar Prinja

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Abstract

Background and objective: Androgen-deprivation therapy is the mainstay of treatment for patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). However, the intensification of treatment with either docetaxel or novel anti-androgens (abiraterone-acetate plus prednisone [AAP], enzalutamide, and apalutamide) is being recommended based on the improved clinical outcomes and quality of life among patients. This study aimed to determine the most cost-effective drug for treatment intensification for patients with mHSPC in India.

Methods: A Markov model was developed with four health states: progression-free survival, progressive disease, best supportive care, and death. Lifetime costs and consequences were estimated for four treatment sequences: AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost effectiveness using a willingness to pay threshold of 1 × per capita gross domestic product in India.

Results: We estimated that the total lifetime cost per patient was ₹1,367,454 (US$17,487), ₹2,168,885 (US$27,735), ₹7,678,501 (US$98,190), and ₹1,358,746 (US$17,375) in the AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first treatment sequence, respectively. The mean quality-adjusted life-years lived per patient were 4.78, 5.03, 3.22, and 2.61, respectively. The AAP-first sequence incurs an incremental cost of ₹4014 (US$51) per quality-adjusted life-year gained as compared with the docetaxel-first sequence, with a 87% probability of being cost effective at the willingness-to-pay threshold of 1 × per-capita gross domestic product of India. The use of AAP-first also incurs an incremental net monetary benefit of ₹396,491 (US$5070) as compared with the docetaxel-first treatment sequence. Nearly a 48% reduction in the price of enzalutamide is required to make it a cost-effective treatment sequence as compared with AAP-first in India.

Conclusions: We concur with the inclusion of standard-dose AAP in India's publicly financed health insurance scheme for the intensification of treatment in mHSPC as it is the only cost-effective sequence among the various novel anti-androgens when compared with the docetaxel-first treatment sequence. Furthermore, a systematic reduction in the price of enzalutamide would further help to improve clinical outcomes among patients with mHSPC.

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印度对转移性激素敏感性前列腺癌加强治疗的系统疗法成本效益分析。

背景和目的：雄激素剥夺疗法是新诊断转移性激素敏感性前列腺癌（mHSPC）患者的主要治疗方法。然而，多西他赛或新型抗雄激素（醋酸阿比特龙加泼尼松[AAP]、恩扎鲁胺和阿帕鲁胺）可改善患者的临床疗效和生活质量，因此被推荐加强治疗。本研究旨在确定印度 mHSPC 患者强化治疗最具成本效益的药物：方法：建立了一个马尔可夫模型，其中包含四种健康状态：无进展生存期、疾病进展期、最佳支持治疗和死亡。对四种治疗顺序的终生成本和后果进行了估算：AAP优先、恩扎鲁胺优先、阿帕鲁胺优先和多西他赛优先。将特定治疗方案的每质量调整生命年（QALY）增量成本与次佳替代方案进行比较，并以印度人均国内生产总值的 1 × 支付意愿阈值评估成本效益：我们估计，在AAP优先、恩扎鲁胺优先、阿帕鲁胺优先和多西他赛优先的治疗顺序中，每位患者的终生总成本分别为₹1,367,454（17,487美元）、₹2,168,885（27,735美元）、₹7,678,501（98,190美元）和₹1,358,746（17,375美元）。每位患者的平均生存质量调整生命年数分别为 4.78、5.03、3.22 和 2.61。与多西他赛先行序列相比，AAP-first 序列每获得一个质量调整生命年的增量成本为 4014 英镑（51 美元），在印度人均国内生产总值 1 × 的支付意愿阈值下，具有成本效益的概率为 87%。与多西他赛优先治疗序列相比，AAP-first 还能带来 396,491 英镑（5070 美元）的净货币增量收益。在印度，与 "AAP-first "治疗序列相比，恩杂鲁胺的价格需要降低近 48%，才能使其成为一种具有成本效益的治疗序列：我们同意将标准剂量 AAP 纳入印度公共医疗保险计划，以加强 mHSPC 的治疗，因为与多西他赛先行治疗序列相比，它是各种新型抗雄激素中唯一具有成本效益的序列。此外，系统性降低恩杂鲁胺的价格将有助于进一步改善mHSPC患者的临床疗效。

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来源期刊

Applied Health Economics and Health Policy Economics, Econometrics and Finance-Economics and Econometrics

CiteScore

6.10

自引率

2.80%

发文量

期刊介绍： Applied Health Economics and Health Policy provides timely publication of cutting-edge research and expert opinion from this increasingly important field, making it a vital resource for payers, providers and researchers alike. The journal includes high quality economic research and reviews of all aspects of healthcare from various perspectives and countries, designed to communicate the latest applied information in health economics and health policy. While emphasis is placed on information with practical applications, a strong basis of underlying scientific rigor is maintained.