Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients

Renske M.T. ten Ham*, Merel van Nuland, Rick A. Vreman, Laurens G. de Graaf, Hilde Rosing, André M. Bergman, Alwin D.R. Huitema, Jos H. Beijnen, Anke M. Hövels

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (Cmin) of abiraterone. Patients with a plasma Cmin below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone Cmin in patients with mCRPC. Methods: A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER). Results: Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively. Conclusions: Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.

Original languageEnglish
Pages (from-to)121-128
Number of pages8
JournalValue in Health
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 2021

Keywords

  • abiraterone
  • cost-effectiveness
  • food
  • prostate cancer
  • therapeutic drug monitoring
  • Quality-Adjusted Life Years
  • Abiraterone Acetate/blood
  • Markov Chains
  • Humans
  • Male
  • Antineoplastic Agents/blood
  • Prostate-Specific Antigen/blood
  • Disease-Free Survival
  • Drug Monitoring/economics
  • Cost-Benefit Analysis
  • Aged
  • Prostatic Neoplasms, Castration-Resistant/drug therapy

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