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- Publisher Website: 10.1038/s41391-019-0161-2
- Scopus: eid_2-s2.0-85068866913
- PMID: 31273290
- WOS: WOS:000514135100014
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Article: Cost-effectiveness analysis of Abiraterone Acetate versus Docetaxel in the management of metastatic castration-sensitive prostate cancer: Hong Kong’s perspective
Title | Cost-effectiveness analysis of Abiraterone Acetate versus Docetaxel in the management of metastatic castration-sensitive prostate cancer: Hong Kong’s perspective |
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Authors | |
Issue Date | 2020 |
Publisher | Nature Publishing Group. The Journal's web site is located at http://www.nature.com/pcan |
Citation | Prostate Cancer and Prostatic Diseases, 2020, v. 23 n. 1, p. 108-115 How to Cite? |
Abstract | 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. |
Persistent Identifier | http://hdl.handle.net/10722/274911 |
ISSN | 2023 Impact Factor: 5.1 2023 SCImago Journal Rankings: 1.711 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chiang, CL | - |
dc.contributor.author | So, TH | - |
dc.contributor.author | Lam, TC | - |
dc.contributor.author | Choi, HCW | - |
dc.date.accessioned | 2019-09-10T02:31:26Z | - |
dc.date.available | 2019-09-10T02:31:26Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | Prostate Cancer and Prostatic Diseases, 2020, v. 23 n. 1, p. 108-115 | - |
dc.identifier.issn | 1365-7852 | - |
dc.identifier.uri | http://hdl.handle.net/10722/274911 | - |
dc.description.abstract | 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. | - |
dc.language | eng | - |
dc.publisher | Nature Publishing Group. The Journal's web site is located at http://www.nature.com/pcan | - |
dc.relation.ispartof | Prostate Cancer and Prostatic Diseases | - |
dc.title | Cost-effectiveness analysis of Abiraterone Acetate versus Docetaxel in the management of metastatic castration-sensitive prostate cancer: Hong Kong’s perspective | - |
dc.type | Article | - |
dc.identifier.email | Chiang, CL: chiangcl@hku.hk | - |
dc.identifier.email | So, TH: sth495@hku.hk | - |
dc.identifier.email | Lam, TC: lamtc03@hku.hk | - |
dc.identifier.email | Choi, HCW: hcchoi@hku.hk | - |
dc.identifier.authority | Chiang, CL=rp02241 | - |
dc.identifier.authority | So, TH=rp01981 | - |
dc.identifier.authority | Lam, TC=rp02128 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1038/s41391-019-0161-2 | - |
dc.identifier.pmid | 31273290 | - |
dc.identifier.scopus | eid_2-s2.0-85068866913 | - |
dc.identifier.hkuros | 302880 | - |
dc.identifier.hkuros | 303269 | - |
dc.identifier.volume | 23 | - |
dc.identifier.issue | 1 | - |
dc.identifier.spage | 108 | - |
dc.identifier.epage | 115 | - |
dc.identifier.isi | WOS:000514135100014 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 1365-7852 | - |