PCN86 Cost-Effectiveness Analysis of Abiraterone for the Treatment of Advanced Prostate Cancer Under the Brazilian Private Health Care System

Abstract

utilities for pazopanib and placebo were from PALETTE. Lacking a connected evidence network, estimates of relative effectiveness for trabectedin and ifosfamide were from an unadjusted indirect treatment comparison vs. pazopanib. Costs were from NHS reference costs and other published sources. RESULTS: Compared with placebo, pazopanib is estimated to increase QALYs by 0.130 and costs by £8,072; the incremental cost effectiveness ratio (ICER) for pazopanib vs. placebo is estimated to be £63k/QALY gained. For most parameters, the ICER changed Ͻ30% with ϩ/Ϫ50% changes in the parameter value. Compared with trabectedin and ifosfamide, pazopanib provides equal or more QALYs at a lower cost. CONCLUSIONS: From a UK health care system perspective, pazopanib may not be cost-effective vs. placebo in patients with advanced/metastatic STS based on criteria typically used to evaluate therapies in the UK. Pazopanib may be cost-effective vs. trabectedin and ifosfamide, although there is substantial uncertainty associated with these comparisons. OBJECTIVES:Eurtact trial was the first randomized phase III trial evaluating efficacy and safety of erlotinib vs chemotherapy in the first-line treatment of EGFR mutϩ Caucasian patients. This trial showed an increase in the median PFS of 4,5 months with erlotinib vs chemotherapy. Based on this study, we aimed to assess the cost-effectiveness of erlotinib versus platinum based chemotherapy in the first-line treatment of advanced NSCLC patients with activating EGFR mutations. METHODS: A health economic cost-effectiveness analysis was developed incorporating a Markov model simulating the evolution of a cohort of advanced NSCLC patients with activating EGFR mutations. Three health states were included: Progression Free Survival (PFS), Progression and Death. The time horizon was 7 years. Outcomes were life years gained (LYG). Resource utilization related to each health state was estimated by a Spanish Expert Panel. Cost were expressed in € 2012 and include drug and administration costs, and drug-related adverse events management cost. This analysis was performed taking into account the Spanish National Health System's perspective. Patient data on progression-free and overall survival were obtained from the EURTAC study. Probabilistic sensitivity analyses were conducted to incorporate parameter uncertainties. RESULTS: Erlotinib treated patients achieved a mean of 2.161 LYG compared to 1.555 LYG in patients receiving chemotherapy. Total mean treatment cost with erlotinib and chemotherapy was €22,458 and €5,335 respectively. The incremental cost-effectiveness ratio (ICER) per LYG was €28,261. Since erlotinib treatment is prolonged until disease progression and chemotherapy is stopped at 4 cycles, treatment duration is one of the cost-driver of the model. CONCLUSIONS: Erlotinib treatment of NSCLC patients with activating EGFR mutations is associated with an increased life expectancy and is a costeffective therapeutic option in Spain. OBJECTIVES:Hormone refractory prostate cancer has generally poor ...

Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer

“…This study found that, in the Brazilian private health system, abiraterone was both more effective at increasing QALYs and providing lower costs as compared to cabazitaxel. ( 21 ) The study by Pereira et al, ( 21 ) is different from ours. First, they assessed the treatment for castration-refractory patients previously treated with docetaxel, while we assessed the treatment for newly diagnosed castration-sensitive disease (median duration of abiraterone therapy 6 months versus 34 months, respectively).…”

Análise de custo-efetividade da abiraterona para câncer de próstata metastático resistente à castração em pacientes com uso prévio de quimioterapia

“…Dados sobre ganho de QALY e anos de vida em outros modelos de custo-efetividade da abiraterona estão disponíveis na literatura internacional. Os resultados desses estudos em termos de QALY e anos de vida ganhos (abiraterona ver- sus tratamento padrão) variam amplamente, havendo dois estudos cujos resultados de 0,06 e 0,27 foram menos favoráveis que o do presente trabalho (Pereira et al, 2012;Zhong et al, 2013); um estudo chegou a 0,30, número quase idêntico ao aqui estimado (Chopra et al, 2012); e dois trabalhos encontraram valores de 0,47 (Marin Piva et al, 2016;Persson et al, 2012), maiores do que os apresentados na presente avaliação. Porém, conhecendo-se o custo do medicamento no Brasil, mesmo que tivéssemos encontrado os valores mais favoráveis da literatura (Marin Piva et al, 2016), os resultados para um limiar de três vezes o PIB per capita ainda não seriam custo-efetivos.…”