Reanalysis of Cost-Effectiveness of Abiraterone Acetate as Second Line Treatment for Metastatic Castration-Resistant Prostate Cancer in Japan Using a Japanese Claim Data Set

Abstract

Objectives: Italian recommendations for human papillomavirus (HPV) immunization currently consider females only. However, males can be vectors in viral transmission and at risk of infection. The BEST II study was designed to evaluate: the cost-effectiveness (CE) of different interventions targeting females as well as males; and the economic impact of vaccination on a wide range of HPV-induced diseases. MethOds: A dynamic Bayesian Markov model was developed to investigate the transmission between sexual partners and the cost-effectiveness of vaccination targeting female and male cohorts in comparison to screening and female cohorts only. A range of HPV-induced diseases was considered (cervical, vaginal, vulvar, anal, head and neck and penile cancer, the associated pre-cancerous stages and anogenital warts). The process of sexual mixing was calculated based on age, gender and sexual behavioural specific matrices to estimate th force of infection dynamically. Increased susceptibility to the virus, associated with early sexual début, a high number of partners, smoking and previous STDs, were included. We considered several scenarios; the baseline assumes universal vaccination to be implemented for 12-year-old females and males. The follow-up period was 55 years. Results: According to our preliminary analysis, universal vaccination resulted in incremental CE ratios (ICERs) corresponding to € 910 and € 5,770, when compared to screeningonly and female-only vaccination, respectively. We performed extensive sensitivity analysis, which confirmed the good CE profile of universal vaccination in Italy. cOnclusiOns: A universal HPV vaccination of male and female programme is more cost-effective than screening and female-only vaccination when accounting for all HPV-related diseases. Universal vaccination programme increase herd immunity and provide indirect protection to unvaccinated girls against HPV. The herd immunity plays a significant role in the economic evaluation of HPV immunization programmes. A universal vaccination may be further useful considering that males are both at risk of infection and vectors in viral transmission.

Realities in cost-effectiveness analyses: a study of castration-resistant prostate cancer patients using a medical claims database

“…Although costs varied widely among the patients, our model estimated the mean health care costs to be ¥97,506 ($952) per patient per month. Our estimate was similar to that of a previous study (Shibahara et al 2014 ), which estimated costs to range from ¥53,090 (US$518) to ¥91,060 (US$889). In addition, our analysis showed that these costs were not strongly associated with death, but were significantly affected by variations in hospitalization and chemotherapies.…”

“…After proof of effectiveness was demonstrated, the cost-effectiveness of abiraterone was investigated. NICE estimated the ICER for abiraterone to be £46,800 (approximately US$50K)/QALY (Dyer et al 2012 ), Zhong et al estimated US$94K/QALY (Zhong et al 2013 ), Wilson et al estimated US$123.4K/QALY (Wilson et al 2014 ), and Shibahara et al estimated US$170K/QALY for Japanese patients (Shibahara et al 2014 ). Although a universally accepted threshold amount has yet to be determined, these estimates can be considered high when using an ICER threshold of US$50K/QALY (Neumann et al 2014 ), thereby indicating that abiraterone may not be cost-effective.…”

“…Shibahara et al (Shibahara et al 2014 ) estimated the ICER of abiraterone for CRPC patients in Japan using models constructed with data from the existing literature and assumptions of general procedures. In this study, we modified these models using real-world data.…”