Cost-Effectiveness Analysis of Abiraterone and Sipuleucel-T in Asymptomatic Metastatic Castration-Resistant Prostate Cancer

Authors: Cynthia L. Gong PharmD 1 and Joel W. Hay PhD 1
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  • 1 From Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California.
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Of patients diagnosed with prostate cancer, 0% to 20% experience disease progression to metastatic castration-resistant prostate cancer (mCRPC). Recently, 4 novel therapies have been introduced for the treatment of mCRPC; of these, abiraterone and sipuleucel-T have been studied in the asymptomatic, pre-docetaxel population. Both have shown clinical benefits compared with placebo. This study evaluated the cost-effectiveness of abiraterone acetate and sipuleucel-T compared with prednisone in asymptomatic, pre-docetaxel mCRPC from a US societal perspective. A Markov model was constructed to simulate stable disease, progressed disease, and death. Survival and event rates were derived from published clinical trial data. Costs were derived from the literature and government reimbursement schedules. Outcomes were measured as average cost-effectiveness ratios (ACERs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). One-way and probabilistic sensitivity analyses were conducted to test the robustness of the model. The base-case ACER was $114K/quality-adjusted life-years (QALY) for abiraterone, $85K/QALY for sipuleucel-T, and $31K/QALY for prednisone. The base-case ICER was $389K/QALY for abiraterone and $547K/QALY for sipuleucel-T. Prednisone dominates both abiraterone and sipuleucel-T in terms of NMB at willingness-to-pay (WTP) thresholds of $400K or less. One-way sensitivity analyses revealed that the model was most sensitive to overall survival and utility inputs. Probabilistic sensitivity analyses showed abiraterone to be cost-effective 50% or more of the time at a WTP of greater than $400K, whereas sipuleucel-T was cost-effective 50% or more of the time at a WTP of greater than $270K. Neither abiraterone nor sipuleucel-T was found to be cost-effective compared with prednisone in the treatment of asymptomatic, pre-docetaxel mCRPC.

Correspondence: Joel W. Hay, PhD, Schaeffer Center for Health Policy & Economics, University of Southern California, University Park Campus, VPD 214-L, Los Angeles, CA 90089-3333. E-mail: JHay@usc.edu
  • 1.

    American Cancer Society. Leading New Cancer Cases and Deaths - 2013 Estimates. Available at: http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2013/index. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 2.

    National Cancer Institute. Surveillance Epidemiology and End Results (SEER) Stat Fact Sheets: Prostate. Available at: http://seer.cancer.gov/statfacts/html/prost.html. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 3.

    Kirby M, Hirst C, Crawford ED. Characterising the castration-resistant prostate cancer population: a systematic review. Int J Clin Pract 2011;65:11801192.

    • Search Google Scholar
    • Export Citation
  • 4.

    Ryan CJ, Smith MR, de Bono JS. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 2013;368:138148.

  • 5.

    Kantoff PW, Higano CS, Shore ND. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 2010;363:411422.

  • 6.

    Mohler JL, Kantoff PW, Armstrong AJ. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2014. Available at: NCCN.org. Accessed April 1, 2014.

    • Search Google Scholar
    • Export Citation
  • 7.

    Zytiga [package insert]. Horsham, PA: Centocor Ortho Biotech; 2011.

  • 8.

    Attard G, de Bono JS. Translating scientific advancement into clinical benefit for castration-resistant prostate cancer patients. Clin Cancer Res 2011;17:38673875.

    • Search Google Scholar
    • Export Citation
  • 9.

    de Bono JS, Logothetis CJ, Molina A. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 2011;364:19952005.

  • 10.

    Provenge [package insert]. Seattle, WA: Dendreon Corporation; June 2011.

  • 11.

    Zhong L, Pon V, Srinivas S. Therapeutic options in docetaxel-refractory metastatic castration-resistant prostate cancer: a cost-effectiveness analysis. PLoS One 2013;8:e64275.

    • Search Google Scholar
    • Export Citation
  • 12.

    National Institute for Health and Clinical Excellence. Abiraterone for Castration-Resistant Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen. NICE Technology Appraisal Guidance, 2012. Available at: guidance.nice.org.uk/ta259. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 13.

    National Institute for Health and Care Excellence. Prostate Cancer (Metastatic, Hormone Relapsed) - Sipuleucel-T (1st Line) [ID573]. NICE Technology Appraisal Guidance. Available at: http://guidance.nice.org.uk/TA/WaveR/156#keydocs. Accessed August 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 14.

    Huber ML, Haynes L, Parker C, Iversen P. Interdisciplinary critique of sipuleucel-T as immunotherapy in castration-resistant prostate cancer. J Natl Cancer Inst 2012;104:273279.

    • Search Google Scholar
    • Export Citation
  • 15.

    Cleeland CS. Brief Pain Inventory User Guide. Available at: http://www.mdanderson.org/education-and-research/departments-programs-and-labs/departments-and-divisions/symptom-research/symptom-assessment-tools/BPI_UserGuide.pdf. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 16.

    Oken MM, Creech RH, Tormey DC. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649655.

  • 17.

    Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the “DEALE”). I. Validation of the method. Am J Med 1982;73:889897.

    • Search Google Scholar
    • Export Citation
  • 18.

    Social Security Administration. Period Life Table, 2010. Available at: http://www.ssa.gov/OACT/STATS/table4c6.html#ss. Accessed August 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 19.

    US Department of Veterans Affairs. Veterans Affairs Federal Supply Schedule. Contract Catalog. Available at: http://www.va.gov/nac/index.cfm?action=search&template=Search_Pharmaceutical_Catalog. Accessed September 13, 2014.

    • Search Google Scholar
    • Export Citation
  • 20.

    Centers for Medicare and Medicaid Services (CMS). Current Procedural Terminology, Fourth Edition. Available at: http://www.cms.gov/apps/physician-fee-schedule/. Accessed June 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 21.

    Hayman JA, Langa KM, Kabeto MU. Estimating the cost of informal caregiving for elderly patients with cancer. J Clin Oncol 2001;19:32193225.

  • 22.

    United States Department of Labor. National Compensation Survey: Employer Cost for Employee Compensation. Bureau of Labor Statistics Web site. Available at: http://www.bls.gov/ncs/data.htm. Accessed June 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 23.

    Centers for Medicare and Medicaid Services (CMS). Medicare Fee For Service Payment - Acute Inpatient PPS. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Acute-Inpatient-Files-for-Download-Items/FY2013-FinalRule-CorrectionNotice-Files.html?DLPage=1&DLSort=1&DLSortDir=descending. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 24.

    Mercaldi CJ, Siu K, Sander SD. Long-term costs of ischemic stroke and major bleeding events among Medicare patients with nonvalvular atrial fibrillation. Cardiol Res Pract 2012;2012:645469.

    • Search Google Scholar
    • Export Citation
  • 25.

    Pignone M, Earnshaw S, Pletcher MJ. Aspirin for the primary prevention of cardiovascular disease in women: a cost-utility analysis. Arch Intern Med 2007;167:290295.

    • Search Google Scholar
    • Export Citation
  • 26.

    Liao L, Anstrom KJ, Gottdiener JS. Long-term costs and resource use in elderly participants with congestive heart failure in the Cardiovascular Health Study. Am Heart J 2007;153:245252.

    • Search Google Scholar
    • Export Citation
  • 27.

    Burton TM, Lacey M, Liu F. One-year follow-up healthcare costs of patients hospitalized for transient ischemic attack or ischemic stroke and discharged with aspirin plus extended-release dipyridamole or clopidogrel. J Med Econ 2012;15:12171225.

    • Search Google Scholar
    • Export Citation
  • 28.

    Mehra M, Wu Y, Dhawan R. Healthcare resource use in advanced prostate cancer patients treated with docetaxel. J Med Econ 2012;15:836843.

  • 29.

    United States Department of Labor. Consumer Price Index - All Urban Consumers: Medical Care. Bureau of Labor Statistics. Available at: http://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths. Accessed July 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 30.

    Gold MR, Siegel JE, Russell LB. Cost-effectiveness in health and medicine. New York, NY: Oxford University Press; 1996.

  • 31.

    Bremner KE, Chong CA, Tomlinson G. A review and meta-analysis of prostate cancer utilities. Med Decis Making 2007;27:288298.

  • 32.

    Volk RJ, Cantor SB, Cass AR. Preferences of husbands and wives for outcomes of prostate cancer screening and treatment. J Gen Intern Med 2004;19:339348.

    • Search Google Scholar
    • Export Citation
  • 33.

    Bennett CL, Chapman G, Elstein AS. A comparison of perspectives on prostate cancer: analysis of utility assessments of patients and physicians. Eur Urol 1997;32(Suppl 3):8688.

    • Search Google Scholar
    • Export Citation
  • 34.

    Yeung K, Gong CL. Cost-utility analysis of enzalutamide versus abiraterone for the treatment of docetaxel refractory metastatic castrate resistant prostate cancer. Presented at the 18th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research; May 18-22, 2013; New Orleans, Louisiana. Poster PCN86.

    • Search Google Scholar
    • Export Citation
  • 35.

    World Health Organization. Cost-Effectiveness Thresholds. CHOosing Interventions that are Cost-Effective (WHO-CHOICE). Available at: http://www.who.int/choice/costs/CER_thresholds/en/. Accessed August 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 36.

    Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analyses. Med Decis Making 1998;18:S6880.

    • Search Google Scholar
    • Export Citation
  • 37.

    O’Day K, Globe D. Using net benefits to report cost-effectiveness results. Presented at the ISPOR Annual European Congress; November 5-8, 2011. Available at: http://www.ispor.org/congresses/Spain1111/presentations/W30_Globe-Oday.pdf. Accessed August 1, 2013.

    • Search Google Scholar
    • Export Citation
  • 38.

    Hwang SS, Chang VT, Alejandro Y, Mulaparthi S. Study of hormone refractory prostate cancer: hospital care and palliative care resource use at a VA medical center. Cancer Invest 2004;22:849857.

    • Search Google Scholar
    • Export Citation
  • 39.

    Schellhammer PF, Chodak G, Whitmore JB. Lower baseline prostate-specific antigen is associated with a greater overall survival benefit from sipuleucel-T in the Immunotherapy for Prostate Adenocarcinoma Treatment (IMPACT) trial. Urology 2013;81:12971302.

    • Search Google Scholar
    • Export Citation
  • 40.

    Affordable Care Act. Patient-Centered Outcomes Research Institute. Patient Protection and Affordable Care Act, 42 U.S.C. § 1182(e). 2010.

    • Search Google Scholar
    • Export Citation
  • 41.

    Nadler E, Eckert B, Neumann PJ. Do oncologists believe new cancer drugs offer good value? Oncologist 2006;11:9095.

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