PMID- 31273290
OWN - NLM
STAT- MEDLINE
DCOM- 20200923
LR  - 20210731
IS  - 1476-5608 (Electronic)
IS  - 1365-7852 (Linking)
VI  - 23
IP  - 1
DP  - 2020 Mar
TI  - Cost-effectiveness analysis of Abiraterone Acetate versus Docetaxel in the 
      management of metastatic castration-sensitive prostate cancer: Hong Kong's 
      perspective.
PG  - 108-115
LID - 10.1038/s41391-019-0161-2 [doi]
AB  - BACKGROUND: Several randomized control trials (RCTs) have showed that adding 
      either abiraterone acetate (AA) or docetaxel (D) to androgen-deprivation therapy 
      (ADT) improves survival of metastatic castration-sensitive prostate cancer 
      patients (mCSPC). Yet, the cost-effectiveness of these treatment options has not 
      been fully compared under Hong Kong's setting. This cost-effectiveness analysis 
      (CEA) serves as the first study in Hong Kong to compare the economic value of 
      these two combinations ADT + AA vs. ADT + D. METHODS: A deterministic Markov 
      model is used to project cost-effectiveness of each treatment until death. 
      Survival curves for progression/death were extracted and digitized from the five 
      RCTs (CHAARTED, LATITUDE, two STAMPEDE (2016/2017), and GETUG-AFU15). Clinically 
      significant adverse events (AEs) were modeled; utility values were obtained from 
      the literature. Primary outcomes were the quality-adjusted life years (QALYs) and 
      incremental cost-effectiveness ratio (ICER). We used the societal perspective 
      from Hong Kong and considered three times of local gross domestic product per 
      capita (GDPpc) as the willingness-to-pay (WTP) threshold (i.e., US$138,649). We 
      estimated the break-even cost of AA in case ADT + AA is not a cost-effective 
      strategy under this WTP threshold. While considering the standard AA dosage 
      (1000 mg) as the main analysis, we also examined the potential impact of the 
      low-dose AA (250 mg) strategy. RESULTS: Integrating simulations with 
      probabilistic sensitivity analysis, ADT + D returns 0.79 (median; 95% credible 
      interval 0.56-0.97) QALY with an ICER of US$14,397/QALY ($7824-22,632) compared 
      to ADT-alone. A head-to-head comparison indicates that ADT + AA further gains 
      0.79 (0.45-1.17) QALY but with an ICER of $361,439/QALY ($260,615-599,683) when 
      compared to ADT + D. Considering three times of GDPpc as WTP threshold, ADT + D 
      is more cost-effective in all simulations; while ADT + AA is more cost-effective 
      than ADT + D only if the cost of AA is reduced by at least 63%. The low-dose AA 
      (250 mg) strategy is potentially cost-effective when it generates equivalent 
      efficacy as the standard dosage (1000 mg). CONCLUSIONS: ADT + D is therefore 
      shown to be a more cost-effective strategy than ADT + AA in metastatic 
      castration-sensitive prostate cancer patients in developed economies. Addition of 
      AA substantially improved QALY compared to D but at a significant cost.
FAU - Chiang, Chi Leung
AU  - Chiang CL
AD  - Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
AD  - Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, 
      Hong Kong, China.
FAU - So, Tsz Him
AU  - So TH
AD  - Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
AD  - Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, 
      Hong Kong, China.
FAU - Lam, Tai Chung
AU  - Lam TC
AD  - Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
AD  - Department of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, 
      Hong Kong, China.
FAU - Choi, Horace C W
AU  - Choi HCW
AD  - Department of Clinical Oncology, University of Hong Kong, Hong Kong, China. 
      hcchoi@hku.hk.
LA  - eng
PT  - Journal Article
DEP - 20190704
PL  - England
TA  - Prostate Cancer Prostatic Dis
JT  - Prostate cancer and prostatic diseases
JID - 9815755
RN  - 15H5577CQD (Docetaxel)
RN  - EM5OCB9YJ6 (Abiraterone Acetate)
SB  - IM
MH  - Abiraterone Acetate/*economics/therapeutic use
MH  - *Cost-Benefit Analysis
MH  - Disease Management
MH  - Docetaxel/*economics/therapeutic use
MH  - Drug Costs
MH  - Health Care Surveys
MH  - Hong Kong/epidemiology
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Prostatic Neoplasms, Castration-Resistant/diagnosis/drug therapy/*epidemiology
MH  - Quality-Adjusted Life Years
MH  - Treatment Outcome
EDAT- 2019/07/06 06:00
MHDA- 2020/09/24 06:00
CRDT- 2019/07/06 06:00
PHST- 2019/03/27 00:00 [received]
PHST- 2019/05/09 00:00 [accepted]
PHST- 2019/05/06 00:00 [revised]
PHST- 2019/07/06 06:00 [pubmed]
PHST- 2020/09/24 06:00 [medline]
PHST- 2019/07/06 06:00 [entrez]
AID - 10.1038/s41391-019-0161-2 [pii]
AID - 10.1038/s41391-019-0161-2 [doi]
PST - ppublish
SO  - Prostate Cancer Prostatic Dis. 2020 Mar;23(1):108-115. doi: 
      10.1038/s41391-019-0161-2. Epub 2019 Jul 4.