Cost-Effectiveness Analysis of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer
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Background: Metastatic castration-resistant prostate cancer poses a therapeutic challenge with poor prognosis. The VISION trial showed prolonged progression-free and overall survival in patients treated with lutetium Lu 177 vipivotide tetraxetan (177Lu-PSMA-617) radioligand therapy compared with using the standard of care (SoC) alone. The objective of this study was to determine the cost-effectiveness of 177Lu-PSMA-617 treatment compared with SoC therapy. Methods: A partitioned survival model was developed using data from the VISION trial, which included overall and progression-free survival and treatment regimens for 177Lu-PSMA-617 and SoC. Treatment costs, utilities for health states, and adverse events were derived from public databases and the literature. Because 177Lu-PSMA-617 was only recently approved, costs for treatment were extrapolated from 177Lu-DOTATATE. Outcome measurements included the incremental cost, effectiveness, and cost-effectiveness ratio. The analysis was performed in a US setting from a healthcare system perspective over the lifetime horizon of 60 months. The willingness-to-pay threshold was set to $50,000, $100,000, and $200,000 per quality-adjusted life years (QALYs). Results: The 177Lu-PSMA-617 group was estimated to gain 0.42 incremental QALYs. Treatment using 177Lu-PSMA-617 led to an increase in costs compared with SoC ($169,110 vs $85,398). The incremental cost, effectiveness, and cost-effectiveness ratio for 177Lu-PSMA-617 therapy was $200,708/QALYs. Sensitivity analysis showed robustness of the model regarding various parameters, which remained cost-effective at all lower and upper parameter bounds. In probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations, therapy using 177Lu-PSMA-617 was determined as the cost-effective strategy in 37.14% of all iterations at a willingness-to-pay threshold of $200,000/QALYs. Conclusions: Treatment using 177Lu-PSMA-617 was estimated to add a notable clinical benefit over SoC alone. Based on the model results, radioligand therapy represents a treatment strategy for patients with metastatic castration-resistant prostate cancer with cost-effectiveness in certain scenarios.
Submitted February 15, 2022; final revision received July 4, 2022; accepted for publication August 22, 2022.
Author contributions: Conception and design: M. Unterrainer, Kunz. Data acquisition: Mehrens. Analysis and interpretation of data: Mehrens, Kramer. Statistical analysis: Mehrens, M. Unterrainer, Kunz. Draft: Mehrens. Supervision: M. Unterrainer, Kunz. Administrative, technical, and material support: Kunz. Critical revision: L. Unterrainer, Beyer, Bartenstein, Froelich, Tollens, Ricke, Rübenthaler, Schmidt-Hegemann, Herlemann.
Disclosures: Dr. Beyer has disclosed serving as a consultant and scientific advisor for Advanced Accelerator Applications, in addition to having other relationships or activities. Dr. Ricke has disclosed receiving grant/research support from and serving on the speakers’ bureau for Sirtex and Bayer. The remaining authors have disclosed not receiving any financial consideration from any person or organization to support the preparation, results, analysis, or discussion of this article.
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