Abstract
Aim: Advanced prostate cancer results in ill-health, disability or early death contributing a high burden on Australian society which be quantified and measured in disability-adjusted life years (DALY). Radionuclide therapy is an effective therapy which may decrease the burden of disease. This study aimed to evaluate the cost-utility of 177Lu-PSMA-I&T versus Cabazitaxel and standard of care (SOC), in metastatic castration-resistant prostate cancer (mCRPC) patients, from the societal perspective in the context of Australia.
Method: Micro-costing was used to capture costs in both direct (medication, administration, monitoring, adverse drug reaction and health outcomes management, and non-medical expenditures) and indirect (patient and caregiver productivity loss) terms. Efficacy outcomes were captured from TheraP and VISION trials and included progression-free survival (PFS), overall survival (OS), pain-PFS and physical function deterioration-free survival (PhyFDeterFS). Health state utilities were captured from the literature. Partitioned survival model was developed and included a cohort of 1000 hypothetical patients. Results were presented in terms of total costs, quality adjusted life years (QALYs), life years gained (LYG) and incremental cost effectiveness ratio (ICER), in a 10-year time horizon. Costs and QALYs were discounted by 5%. Scenario analysis was conducted considering a 5-year time horizon. Deterministic and probabilistic sensitivity analysis were conducted to evaluate the robustness of the results.
Results: Due to better health outcomes, 177Lu-PSMA was associated with higher QALYs and LYG versus Cabazitaxel (0.0575 QALYs, 0.021 years) and SOC (0.2481 QALYs and 0.378 years). 177Lu-PSMA was also associated with increase in total costs of 225 and 31 453 AUD, which resulted in ICER of 3914 and 126 784 AUD/QALY versus Cabazitaxel and SOC, respectively. Results were mostly sensitive to transition probabilities, drug costs and number of the cycles. In addition, scenario analysis indicated that a 5-year time horizon decreased ICERs by 155% and 94% versus Cabazitaxel and SOC, respectively. Probabilistic sensitivity analysis indicated that 177Lu- PSMA remains cost-effective versus Cabazitaxel, in +70% of scenarios.
Conclusion: 177Lu-PSMA was associated with substantial benefits in terms of QALYs and LYG, versus chemotherapy and SOC. Although it was associated with increased in costs, 177Lu-PSMA could be considered as a cost-effective strategy in mCRPC Australian patients.
Method: Micro-costing was used to capture costs in both direct (medication, administration, monitoring, adverse drug reaction and health outcomes management, and non-medical expenditures) and indirect (patient and caregiver productivity loss) terms. Efficacy outcomes were captured from TheraP and VISION trials and included progression-free survival (PFS), overall survival (OS), pain-PFS and physical function deterioration-free survival (PhyFDeterFS). Health state utilities were captured from the literature. Partitioned survival model was developed and included a cohort of 1000 hypothetical patients. Results were presented in terms of total costs, quality adjusted life years (QALYs), life years gained (LYG) and incremental cost effectiveness ratio (ICER), in a 10-year time horizon. Costs and QALYs were discounted by 5%. Scenario analysis was conducted considering a 5-year time horizon. Deterministic and probabilistic sensitivity analysis were conducted to evaluate the robustness of the results.
Results: Due to better health outcomes, 177Lu-PSMA was associated with higher QALYs and LYG versus Cabazitaxel (0.0575 QALYs, 0.021 years) and SOC (0.2481 QALYs and 0.378 years). 177Lu-PSMA was also associated with increase in total costs of 225 and 31 453 AUD, which resulted in ICER of 3914 and 126 784 AUD/QALY versus Cabazitaxel and SOC, respectively. Results were mostly sensitive to transition probabilities, drug costs and number of the cycles. In addition, scenario analysis indicated that a 5-year time horizon decreased ICERs by 155% and 94% versus Cabazitaxel and SOC, respectively. Probabilistic sensitivity analysis indicated that 177Lu- PSMA remains cost-effective versus Cabazitaxel, in +70% of scenarios.
Conclusion: 177Lu-PSMA was associated with substantial benefits in terms of QALYs and LYG, versus chemotherapy and SOC. Although it was associated with increased in costs, 177Lu-PSMA could be considered as a cost-effective strategy in mCRPC Australian patients.
| Original language | English |
|---|---|
| Number of pages | 1 |
| Journal | Internal Medicine Journal |
| Volume | 53 |
| Issue number | S4 |
| DOIs | |
| Publication status | Published - Nov 2023 |
| Externally published | Yes |
| Event | Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine 2023 - Adelaide Convention Centre, Adelaide, Australia Duration: 26 May 2023 → 28 May 2023 Conference number: 53rd https://anzsnm2023.com.au/ |
