Department of Surgery, Finnmark Hospital Trust, 9600, Hammerfest, Norway.
Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
Pharmacoeconomics. 2017 Dec;35(12):1223-1236. doi: 10.1007/s40273-017-0555-8.
Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC).
We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers.
A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument.
A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In most studies, cabazitaxel was not recommended, because of high cost. Looking at bone-targeting drugs, generic zoledronic acid (ZA) was recommended. External beam radiotherapy (EBRT) was analysed in three studies, and single fraction radiotherapy was concluded to be cost saving. Radium-223 was documented as beneficial, but costly. The quality of the studies was generally good, but sensitivity analyses, discounting and the measurement of health outcomes were present in less than two thirds of the selected studies.
The treatment of mCRPC was associated with significant cost. In the post-docetaxel setting, single fraction radiotherapy and enzalutamide were considered cost-effective in most studies. Generic ZA was the recommended bone-targeting therapy.
前列腺癌（PC）是西方国家最常见的癌症。超过三分之一的 PC 患者会发展为转移性疾病，远处疾病的 5 年预期生存率约为 35%。在过去的几年中，已经推出了新的治疗方法来治疗转移性去势抵抗性前列腺癌（mCRPC）。
我们旨在综述转移性前列腺癌（mPC）治疗的卫生经济学分析的现有文献，对研究进行比较，总结发现结果，并将结果提供给管理人员和决策者。
我们对经济性评估（最小成本、成本效果、成本效用、疾病成本、药物成本和成本效益分析）进行了系统的文献检索。我们使用了 PubMed 搜索引擎，检索了 2012 年至 2016 年期间发表的文献。使用的术语是“前列腺癌”、“转移性”和“成本”。对所有标题进行了初步筛选，分析了选定的摘要，最后对全文进行了调查。分析了研究特征、治疗方法和比较、国家、评估类型、视角、价值年、时间范围、疗效数据、贴现率、总成本和敏感性分析。使用健康经济研究质量（QHES）工具对质量进行了评估。
共发现 227 篇出版物并进行了筛选，选择了 58 篇进行全文评估，并纳入了 31 篇最终分析。尽管国际上对 mCRPC 的治疗有大量的文献，但只有 15 项研究侧重于成本效果分析（CEA）。药物治疗构成了选定研究的三分之二。在 mCRPC 的治疗中发现了显著的成本。在多西紫杉醇预处理环境中，醋酸阿比特龙（AA）和恩扎鲁胺均被认为超出了可接受的成本/质量调整生命年限制。在多西紫杉醇难治性环境中，大多数研究表明恩扎卢胺具有成本效益，优于 AA。在大多数研究中，由于成本高，不推荐使用卡巴他赛。在骨靶向药物方面，推荐使用通用唑来膦酸（ZA）。放射治疗（EBRT）在三项研究中进行了分析，单次放射治疗被认为具有成本效益。镭-223被证明是有益的，但代价高昂。研究的质量总体良好，但敏感性分析、贴现和健康结果的测量在选定研究中不到三分之二。
mCRPC 的治疗与显著的成本有关。在后多西紫杉醇环境中，大多数研究认为单次放射治疗和恩扎鲁胺具有成本效益。通用 ZA 是推荐的骨靶向治疗药物。
