Economic evaluation of abiraterone acetate for the treatment of metastatic castration-resistant prostate cancer patients previously treated with docetaxel under the Brazilian private healthcare system

Abstract

Objective: To estimate the incremental cost-effectiveness ratio of abiraterone acetate (AA) plus prednisolone for the treatment of advanced metastatic castration-resistant prostate cancer (mCRPC) after docetaxel, under the Brazilian Private Health System perspective. Methods: A cost-effectiveness analysis was developed based on a Markov model to simulate the disease progression and patient mortality. A systematic review of the literature was developed over the efficacy and safety of the use of AA and cabazitaxel (C), both combined with prednisolone (P), in patients diagnosed with advanced mCRPC. Data was combined and adjusted using an indirect comparison to determine the relative efficacy of each comparator. Costs and consequences were computed for each treatment alternative, considering only direct medical costs. Costs and outcomes were discounted at 5% annually. Results: The cost-effectiveness analysis demonstrated that AA is the least costly medication available. AA was dominant with regards to C, being more effective (LY: 1.3559 vs 1.2895; QALY: 0.7977 vs 0.7329) with lower costs (R$ 79,571 vs R$ 92,475). Infusional costs and costs related to the treatment and prevention of adverse events represented 49% of total savings with AA. Probabilistic sensitivity analysis demonstrated that results were robust, showing a probability of 76.2% that AA had lower cost than C, being cost-saving in 57.6% of these results. Conclusion: Abiraterone acetate is the dominant option compared to cabazitaxel from the Brazilian private perspective; it has a better estimated effectiveness (increase of 0.0664LY and 0.0647QALY) and lower costs (savings of R$12,905) for the treatment of patients diagnosed with advanced mCRPC.