Quist S W, Paulissen J H J, Wyndaele D N J, Nagarajah J, Freriks R D
Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Asc Academics, Groningen, The Netherlands.
J Med Econ. 2023 Jan-Dec;26(1):366-375. doi: 10.1080/13696998.2023.2183618.
The radiopharmaceuticals radium-223 and the pharmacy preparation Lu-PSMA-I&T are reimbursed in the Netherlands for metastatic castration-resistant prostate cancer (mCRPC) treatment. Although shown to be life-prolonging in patients with mCRPC, the treatment procedures associated with these radiopharmaceuticals can be challenging for both patients and hospitals. This study investigates the costs of mCRPC treatment in Dutch hospitals for currently reimbursed radiopharmaceuticals with a demonstrated overall survival benefit.
A cost model that calculated the direct medical per-patient costs of radium-223 and Lu-PSMA-I&T was developed, following clinical trial regimens. The model considered six 4-weekly administrations (i.e. ALSYMPCA regimen) of radium-223. Regarding Lu-PSMA-I&T, the model used both the VISION regimen (i.e. five 6-weekly administrations) and the SPLASH regimen (i.e. four 8-weekly administrations). Based on health insurance claims, we also estimated the coverage a hospital would receive for providing treatment. No fitting health insurance claim for Lu-PSMA-I&T is currently available; therefore, we calculated a break-even value for a potential health insurance claim that would exactly counterbalance the per-patient costs and coverage.
Radium-223 administration is associated with per-patient costs of €30,905, and these costs are fully covered by the coverage a hospital receives. The per-patient costs of Lu-PSMA-I&T range between €35,866 and €47,546 per administration period, depending on the regimen. Current healthcare insurance claims do not fully cover the costs of providing Lu-PSMA-I&T: hospitals must pay €4,414-€4,922 for each patient out of their own budget. The break-even value for the potential insurance claim covering Lu-PSMA-I&T administration with a VISION (SPLASH) regimen is €1,073 (€1,215).
This study shows that, without consideration of the treatment effect, radium-223 treatment for mCRPC leads to lower per-patient costs than treatment with Lu-PSMA-I&T. The detailed overview of the costs associated with radiopharmaceutical treatment provided by this study is relevant for both hospitals and healthcare insurers.
放射性药物镭 - 223和药物制剂镥 - 前列腺特异性膜抗原 - 碘 - 三甲基碘化胺（Lu - PSMA - I&T）在荷兰被用于转移性去势抵抗性前列腺癌（mCRPC）的治疗报销。尽管已证明对mCRPC患者有延长生命的作用，但与这些放射性药物相关的治疗程序对患者和医院来说都可能具有挑战性。本研究调查了荷兰医院中使用目前已报销且具有总体生存获益证明的放射性药物进行mCRPC治疗的成本。
根据临床试验方案，建立了一个计算镭 - 223和Lu - PSMA - I&T每位患者直接医疗成本的成本模型。该模型考虑了镭 - 223的六个每四周一次的给药方案（即ALSYMPCA方案）。对于Lu - PSMA - I&T，该模型使用了VISION方案（即五个每六周一次的给药方案）和SPLASH方案（即四个每八周一次的给药方案）。基于医疗保险理赔数据，我们还估算了医院提供治疗将获得的报销额度。目前尚无适用于Lu - PSMA - I&T的医疗保险理赔数据；因此，我们计算了一个潜在医疗保险理赔的盈亏平衡点，该平衡点将恰好抵消每位患者的成本和报销额度。
镭 - 223给药的每位患者成本为30,905欧元，且这些成本可由医院获得的报销额度完全覆盖。根据治疗方案不同，Lu - PSMA - I&T每次给药周期的每位患者成本在35,866欧元至47,546欧元之间。目前的医疗保险理赔不能完全覆盖提供Lu - PSMA - I&T的成本：医院必须从自身预算中为每位患者支付4,414欧元至4,922欧元。采用VISION（SPLASH）方案的覆盖Lu - PSMA - I&T给药的潜在保险理赔的盈亏平衡点为1,073欧元（1,215欧元）。
本研究表明，在不考虑治疗效果的情况下，mCRPC的镭 - 223治疗导致的每位患者成本低于Lu - PSMA - I&T治疗。本研究提供的放射性药物治疗相关成本的详细概述对医院和医疗保险公司均具有参考价值。
