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 language | English |
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Pages (from-to) | 121-128 |
Number of pages | 8 |
Journal | Value in Health |
Volume | 24 |
Issue number | 1 |
DOIs | |
Publication status | Published - 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