Litvin Valentyn, Aprikian Armen G, Dragomir Alice
Faculty of Pharmacy, University of Montréal, Montréal, QC H3T 1J4, Canada.
Division of Urology, McGill University, Montréal, QC H4A 3J1, Canada.
Curr Oncol. 2025 Apr 20;32(4):240. doi: 10.3390/curroncol32040240.
There has been a proliferation of novel treatments for the management of advanced prostate cancer (PCa), including androgen receptor pathway inhibitors (ARPI). Although there are health economic analyses of novel PCa treatments, such as ARPIs for specific health states, there is a lack of sequential analyses. Our paper aims to fill this gap. We developed a Monte Carlo Markov model to simulate the management of advanced PCa to end-of-life. We modeled patients who begin in metastatic and nonmetastatic castration-sensitive PCa (mCSPC and nmCSPC), with risk stratification for mCSPC, progressing to metastatic castration-resistant PCa (mCRPC). Using current guidelines and recent literature, we simulated admissible treatment sequences over these states along a 15-year horizon. We report the best treatment sequences in terms of efficacy and cost-effectiveness. We find that the most cost-effective use of ARPIs is early in advanced PCa for a cost-effectiveness threshold (CET) of CAD 100K per QALY. For a CET of CAD 50K per QALY, early ARPI use is most cost-effective in mCSPC-starting patients but not nmCSPC-starting. We conclude that the most cost-effective way to use ARPIs is when patients first enter advanced PCa. The most cost-effective ARPI at current Canadian prices is abiraterone, mostly due to abiraterone's lower price level.
对于晚期前列腺癌（PCa）的治疗，出现了大量新的治疗方法，包括雄激素受体通路抑制剂（ARPI）。尽管有针对新的PCa治疗方法的卫生经济学分析，例如针对特定健康状态的ARPI，但缺乏序贯分析。我们的论文旨在填补这一空白。我们开发了一个蒙特卡洛马尔可夫模型，以模拟晚期PCa直至生命结束的治疗过程。我们对开始处于转移性和非转移性去势敏感性PCa（mCSPC和nmCSPC）的患者进行建模，并对mCSPC进行风险分层，这些患者会进展为转移性去势抵抗性PCa（mCRPC）。根据当前指南和近期文献，我们在15年的时间范围内模拟了这些状态下可接受的治疗序列。我们报告了在疗效和成本效益方面最佳的治疗序列。我们发现，对于每质量调整生命年（QALY）成本效益阈值（CET）为10万加元的情况，ARPI最具成本效益的使用时机是在晚期PCa的早期。对于每QALY的CET为5万加元的情况，早期使用ARPI在以mCSPC起始的患者中最具成本效益，但在以nmCSPC起始的患者中并非如此。我们得出结论，使用ARPI最具成本效益的方式是在患者首次进入晚期PCa时。按照加拿大目前的价格，最具成本效益的ARPI是阿比特龙，这主要是由于阿比特龙的价格水平较低。
