New therapeutic options in metastatic castration-resistant prostate cancer: Can cost-effectiveness analysis help in treatment decisions? Academic Article uri icon


  • Objective: To evaluate the cost-effectiveness of abiraterone, cabazitaxel, and enzalutamide compared to placebo for treatment of metastatic castration-resistant prostate cancer. Material and methods: A decision-tree model compared three treatment options for metastatic castration-resistant prostate cancer patients over 18 months from a societal perspective in 2012 USD. Chance nodes included baseline pain as a severity indicator, significant adverse effects (neutropenia, cardiac events, or seizures), and survival. Probabilities, survival rates, and health utilities were from clinical trials (COU-AA, TROPIC, and AFFIRM) and other published studies. Survival of enzalutamide was adjusted to match placebo groups across trials. Probabilistic sensitivity analyses, acceptability curves and net benefit calculations were performed. Results: Abiraterone was the most cost-effective of the treatments ($123.4K/quality-adjusted life year) compared to placebo, enzalutamide was $437.6K/quality-adjusted life year compared to abiraterone, and cabazitaxel was $351.9K/quality-adjusted life year compared to enzalutamide. Enzalutamide and cabazitaxel were not cost-effective compared to placebo at $154.3K/quality-adjusted life year and $163.2K/quality-adjusted life year, respectively. Acceptability curves showed abiraterone was cost-effective 29.3% of the time with a willingness to pay threshold of $100K. The model was sensitive to changes in cost of the drugs, life expectancy, and survival rate. Sensitivity analysis shows that enzalutamide can become the most cost-effective option if the price of the medication decreased by 26% and other drug costs remained the same. Conclusion: Based on the cost-effective analysis, and survival adjustments necessary to match placebo groups, we would recommend abiraterone for treatment of metastatic castration-resistant prostate cancer despite not quite falling under the usually accepted willingness to pay threshold. Further analysis should examine comparative survival across the three drugs.

published proceedings

  • Journal of Oncology Pharmacy Practice

altmetric score

  • 4.25

author list (cited authors)

  • Wilson, L., Tang, J., Zhong, L., Balani, G., Gipson, G., Xiang, P., Yu, D., & Srinivas, S.

citation count

  • 22

complete list of authors

  • Wilson, Leslie||Tang, Jun||Zhong, Lixian||Balani, Gregory||Gipson, Gregory||Xiang, Pin||Yu, Dawn||Srinivas, Sandy

publication date

  • December 2014