Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor targeted agents matter?

Amanda Pereira-Salgado, Angelyn Anton, Fanny Franchini, Robert K Mahar, Edmond M Kwan, Shirley Wong, Julia Shapiro, Andrew Weickhardt, Arun A Azad, Lavinia Spain, Ashray Gunjur, Javier Torres, Phillip Parente, Francis Parnis, Jeffrey Goh, Christopher Steer, Stephen Brown, Peter Gibbs, Ben Tran, Maarten IJzerman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: Health economic outcomes of real-world treatment sequencing of androgen receptor-targeted agents (ARTA) and docetaxel (DOC) remain unclear. Material and Methods: Data from the electronic Castration-resistant Prostate cancer Australian Database (ePAD) were analyzed including median overall survival (mOS) and median time-to-treatment failure (mTTF). Mean total costs (mTC) and incremental cost-effectiveness ratios (ICER) of treatment sequences were estimated using the average sample method and Zhao and Tian estimator. Results: Of 752 men, 441 received ARTA, 194 DOC, and 175 both sequentially. Of participants treated with both, first-line DOC followed by ARTA was the more common sequence (n = 125, 71%). mOS for first-line ARTA was 8.38 years (95% CI: 3.48, not-estimated) vs. 3.29 years (95% CI: 2.92, 4.02) for DOC. mTTF was 15.7 months (95% CI: 14.2, 23.7) for the ARTA-DOC sequence and 18.2 months (95% CI: 16.2, 23.2) for DOC-ARTA. In first-line, ARTA cost an additional $13,244 per mTTF month compared to DOC. In second-line, ARTA cost $6726 per mTTF month. The DOC-ARTA sequence saved $2139 per mTTF compared to ARTA-DOC, though not statistically significant. Conclusion: ICERs show ARTA had improved clinical benefit compared to DOC but at higher cost. There were no significant cost differences between combined sequences.

Original languageEnglish
JournalExpert review of pharmacoeconomics & outcomes research
Early online date28 Dec 2022
DOIs
Publication statusE-pub ahead of print - 28 Dec 2022
Externally publishedYes

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