From Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California.
J Natl Compr Canc Netw. 2014 Oct;12(10):1417-25. doi: 10.6004/jnccn.2014.0139.
Of patients diagnosed with prostate cancer, 0% to 20% experience disease progression to metastatic castration-resistant prostate cancer (mCRPC). Recently, 4 novel therapies have been introduced for the treatment of mCRPC; of these, abiraterone and sipuleucel-T have been studied in the asymptomatic, pre-docetaxel population. Both have shown clinical benefits compared with placebo. This study evaluated the cost-effectiveness of abiraterone acetate and sipuleucel-T compared with prednisone in asymptomatic, pre-docetaxel mCRPC from a US societal perspective. A Markov model was constructed to simulate stable disease, progressed disease, and death. Survival and event rates were derived from published clinical trial data. Costs were derived from the literature and government reimbursement schedules. Outcomes were measured as average cost-effectiveness ratios (ACERs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). One-way and probabilistic sensitivity analyses were conducted to test the robustness of the model. The base-case ACER was $114K/quality-adjusted life-years (QALY) for abiraterone, $85K/QALY for sipuleucel-T, and $31K/QALY for prednisone. The base-case ICER was $389K/QALY for abiraterone and $547K/QALY for sipuleucel-T. Prednisone dominates both abiraterone and sipuleucel-T in terms of NMB at willingness-to-pay (WTP) thresholds of $400K or less. One-way sensitivity analyses revealed that the model was most sensitive to overall survival and utility inputs. Probabilistic sensitivity analyses showed abiraterone to be cost-effective 50% or more of the time at a WTP of greater than $400K, whereas sipuleucel-T was cost-effective 50% or more of the time at a WTP of greater than $270K. Neither abiraterone nor sipuleucel-T was found to be cost-effective compared with prednisone in the treatment of asymptomatic, pre-docetaxel mCRPC.
在被诊断患有前列腺癌的患者中，有 0%至 20%的患者会出现疾病进展，发展为转移性去势抵抗性前列腺癌（mCRPC）。最近，有 4 种新的治疗方法被引入用于治疗 mCRPC；其中，阿比特龙和 sipuleucel-T 已在无症状、多西他赛前人群中进行了研究。与安慰剂相比，这两种药物都显示出了临床益处。本研究从美国社会角度评估了醋酸阿比特龙和 sipuleucel-T 与泼尼松相比在无症状、多西他赛前 mCRPC 中的成本效益。构建了一个 Markov 模型来模拟稳定疾病、进展疾病和死亡。生存和事件率源自已发表的临床试验数据。成本源自文献和政府报销计划。结果以平均成本效益比（ACER）、增量成本效益比（ICER）和净货币效益（NMB）来衡量。进行了单因素和概率敏感性分析以测试模型的稳健性。基础案例的 ACER 分别为阿比特龙 114 千美元/质量调整生命年（QALY）、sipuleucel-T 85 千美元/QALY 和泼尼松 31 千美元/QALY。基础案例的 ICER 分别为阿比特龙 389 千美元/QALY 和 sipuleucel-T 547 千美元/QALY。在支付意愿（WTP）阈值为 40 万美元或以下时，泼尼松在 NMB 方面优于阿比特龙和 sipuleucel-T。单因素敏感性分析表明，模型对总体生存和效用输入最敏感。概率敏感性分析表明，在支付意愿大于 40 万美元时，阿比特龙有 50%或更多的时间是具有成本效益的，而在支付意愿大于 270 万美元时，sipuleucel-T 有 50%或更多的时间是具有成本效益的。在治疗无症状、多西他赛前 mCRPC 方面，阿比特龙和 sipuleucel-T 都不比泼尼松更具成本效益。
