Economic Outcomes in Patients with Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer Treated with Enzalutamide or Abiraterone Acetate Plus Prednisone

Abstract

Introduction: Prostate cancer (PC) is the second leading cause of cancer death among US men and accounts for considerable healthcare expenditures. We evaluated economic outcomes in men with chemotherapy-naïve metastatic castration-resistant PC (mCRPC) treated with enzalutamide or abiraterone acetate plus prednisone (abiraterone). Methods: We performed a retrospective analysis on 3174 men (18 years or older) utilizing the Veterans Health Administration (VHA) database from 1 April 2014 to 31 March 2018. Men with mCRPC were included if they had at least one pharmacy claim for enzalutamide or abiraterone (first claim date = index date) following surgical or medical castration, had no chemotherapy treatment within 12 months prior to the index date, and had continuous VHA enrollment for at least 12 months preand post-index date. Men were followed until death, disenrollment, or end of study and were 1:1 propensity score matched (PSM). All-cause and PC-related resource use and costs per patient per month (PPPM) in the 12 months post index were compared between matched cohorts. Results: We identified 1229 men with mCRPC prescribed enzalutamide and 1945 prescribed

Healthcare Costs for Metastatic Castration-Resistant Prostate Cancer Patients Treated with Abiraterone or Enzalutamide

“…The studies also varied in their focus of settings: three included only pre-chemotherapy setting [10][11][12] and two included both pre-and post-chemotherapy settings [8,9]. In most studies including both treatments, patients were frequently prescribed abiraterone [8,[10][11][12]. This pattern was observed in our study as well.…”

“…There were a handful of studies based on real-world data with which we could compare our results. The treatment stratification in these studies differed: one focused only on abiraterone patients [9], none focused on enzalutamide patients exclusively, and four focused on both treatments [8,[10][11][12]. The studies also varied in their focus of settings: three included only pre-chemotherapy setting [10][11][12] and two included both pre-and post-chemotherapy settings [8,9].…”

“…The treatment stratification in these studies differed: one focused only on abiraterone patients [9], none focused on enzalutamide patients exclusively, and four focused on both treatments [8,[10][11][12]. The studies also varied in their focus of settings: three included only pre-chemotherapy setting [10][11][12] and two included both pre-and post-chemotherapy settings [8,9]. In most studies including both treatments, patients were frequently prescribed abiraterone [8,[10][11][12].…”

“…A recent systematic review [7] on cost-effectiveness analyses and cost analyses of mCRPC treatments confirms these uncertainties, including those attributed to misleading or missing cost information, and insufficient details provided by analyses in its consideration. Moreover, few costing studies [8][9][10][11][12] have to date utilised real-world data despite the expansion in prescription of abiraterone and enzalutamide to patients in the last decade. These studies utilised data obtained from claims and research databases such as the IBM MarketScan ® from the providers' perspectives.…”

Discussion of Treatment Options for Metastatic Hormone Sensitive Prostate Cancer Patients

“…The Asian Pacific regional group indicated cost and access issues are major influences in the real-world application of best practices (24). An economic analysis of men with mCRPC prescribed enzalutatimde compared to abiraterone found the enzalutamide group had lower all-cause outpatient costs due to lower number of visits, and lower pharmacy costs (25). Thus, in resource stricken countries ADT is the most cost effective therapy for mHSPC patients, and if chemohormonal therapy can be combined with ADT then 6 cycles of docetaxel is likely most cost effective, though additional economic analyses are required in the mHSPC population to investigate the cost effectiveness of the new chemohormonal agents available to this patient population.…”