Cost-effectiveness of abiraterone treatment in patients with castration-resistant prostate cancer who previously received docetaxel therapy

Background. Therapy for metastatic castration-resistant prostate cancer (CRPC) is a serious problem that requires significant public health care expenditures.

Objective: to evaluate the cost-effectiveness of abiraterone treatment in patients with metastatic CRPC who previously received docetaxel under the conditions of the budgetary public health system of the Russian Federation.

Material and methods. Markovian simulation based on the COU-AA-301 randomized placebo-controlled Phase III study was used. Survival analysis was made in 70-year-old patients. The cost of abiraterone therapy corresponded to that of the 2013 auctions.

Results. Abiraterone therapy in patients who have previously received docetaxel therapy causes an increase in average life expectancy by an average of 4.6 months and progression-free survival by 2.0 months. Moreover, the cost calculated with reference to one year of additional life will account for about 3.6 million rubles and that to one additional quality-adjusted life year will be about 5.45 million rubles.

Conclusion. The cost-effectiveness of abiraterone therapy for metastatic CRPC in patients who have previously received docetaxel therapy is similar to that of other medicaments used in oncological practice under the conditions of the budgetary public health system of the Russian Federation. In this connection, abiraterone may be considered as an economically acceptable medical intervention in this clinical situation.

1. Mohler J.L., Armstrong A.J., Bahnson R.R. et al. Prostate cancer, Version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2012;10:1081–7.

2. Horwich A., Hugosson J., de Reijke T. et al. Prostate cancer: ESMO Consensus Conference Guidelines 2012. Ann Oncol 2013;24:1141–62.

3. Fizazi K., Scher H., Molina A. et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2012;13(10): 983–92.

4. Bayoumi A., Brown A., Garber A. Cost-effectiveness of androgen suppression therapies in advanced prostate cancer. J Nat Canc Institute 2000;92(21): 1731–9.

5. Life tables for WHO Member States. Russian Federation. 2011. (www.who.int)

6. Когон Л.А. Обоснование методических подходов к оптимизации лекарственного обеспечения больных раком предстательной железы на основе результатов фармакоэкономического и фармакоэпидемиологического анализа. Автореф. дис. … канд. фарм. наук. Научный центр экспертизы средств медицинского применения МЗ РФ. Курск, 2013. 24 с.

7. Hlatky M., Owens D., Sanders G. Costeffectiveness as an outcome in randomized clinical trials. Clin Trials 2006;3;543.

8. Rawlins M., Culyer A. National Institute for Clinical Excellence and its value judgments. BMJ 2004;329:224–7.

9. Resch В., Gusenleitnerl W., Nuijten M. et al. Cost-effectiveness of palivizumab against respiratory syncytial viral infection in high-risk children in Austria. Clin Therapeutics 2008;30(4):749–60.

10. World Health Organization. Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health. Geneva (Switzerland): World Health Organization, 2001.

11. Chabot I., Rocchi A. How do costeffectiveness analyses inform reimbursement decisions for oncology medicines in Canada? The example of sunitinib for first-line treatment of metastatic renal cell carcinoma. Value Health 2010;13(6):837–45.

12. Nadler E.S., Eckert B., Neumann P. Do oncologists believe new cancer drugs offer good value? ASCO Meeting Abstracts 2005;23:6011.

13. Rocchi A., Menon D., Verma S., Miller E. The role of economic evidence in Canadian oncology reimbursement decision-making: to lambda and beyond. Value Health 2008; 11(4):771–83.

14. Куликов А.Ю. Фармакоэкономическая оценка лекарственных средств эрлотиниб, доцетаксел, пеметрексед и гефитиниб в терапии второй линии местно-распространенного или метастатического немелкоклеточного рака легкого. Фармакоэкономика. Совр фармакоэкономика и фармакоэпидемиология 2012;3: 8–12.

15. Chopra A., Gluck S., Montero A. et al. Cost-effectiveness evaluation of abiraterone in the treatment of patients with castrationresistant prostate cancer who previously received docetaxel. J Clin Oncol 2012 ASCO Annual Meeting Abstracts;30(15 suppl): e15107.

16. de Bono J.S., Oudard S., Ozguroglu M. et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castrationresistant prostate cancer progressing after docetaxel treatment: A randomised open-label trial. Lancet 2010;376:1147–54.

17. Колбин А.С., Курылев А.А., Прасолов А.В., Павлыш А.В. Кабазитаксел во второй линии химиотерапии рака предстательной железы – клинико-экономическая оценка. Качественная клин практ 2013;1:2–14.

18. Bahl A., Oudard S., Tombal B. et al. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial. Ann Oncol 2013;24:2402–8.

19. El-Amm J., Aragon-Ching J. The changing landscape in the treatment of metastatic castration-resistant prostate cancer. Ther Adv Med Oncol 2013;5:25.

20. Rathkopf D., Smith M., De Bono J. et al. Updated interim analysis (IA) of COU-AA-302, a randomized phase III study of abiraterone acetate (AA) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) without prior chemotherapy. ASCO Meeting Abstracts, Feb 2013;31:5.