Cost-Effectiveness Analysis of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer

Authors:
Dirk MehrensDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Dirk Mehrens in
Current site
Google Scholar
PubMed
Close
 MD
,
Kristina K.M. KramerDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Kristina K.M. Kramer in
Current site
Google Scholar
PubMed
Close
 BA
,
Lena M. UnterrainerDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Lena M. Unterrainer in
Current site
Google Scholar
PubMed
Close
 MD, MHBA
,
Leonie BeyerDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Leonie Beyer in
Current site
Google Scholar
PubMed
Close
 MD
,
Peter BartensteinDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Peter Bartenstein in
Current site
Google Scholar
PubMed
Close
 MD
,
Matthias F. FroelichDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany

Search for other papers by Matthias F. Froelich in
Current site
Google Scholar
PubMed
Close
 MD, MHBA
,
Fabian TollensDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany

Search for other papers by Fabian Tollens in
Current site
Google Scholar
PubMed
Close
 MD, MSc
,
Jens RickeDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Jens Ricke in
Current site
Google Scholar
PubMed
Close
 MD
,
Johannes RübenthalerDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Johannes Rübenthaler in
Current site
Google Scholar
PubMed
Close
 MD, MHBA
,
Nina-Sophie Schmidt-HegemannDepartment of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Nina-Sophie Schmidt-Hegemann in
Current site
Google Scholar
PubMed
Close
 MD
,
Annika HerlemannDepartment of Urology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Annika Herlemann in
Current site
Google Scholar
PubMed
Close
 MD
,
Marcus UnterrainerDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Marcus Unterrainer in
Current site
Google Scholar
PubMed
Close
 MD, PhD, MHBA
, and
Wolfgang G. KunzDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany

Search for other papers by Wolfgang G. Kunz in
Current site
Google Scholar
PubMed
Close
 MD, MHBA

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.

Correspondence: Wolfgang G. Kunz, MD, MHBA, Department of Radiology, University Hospital, LMU Munich, Research Group PI Health Economics, Marchioninistrasse 15, 81377 Munich, Germany. Email: wolfgang.kunz@med.lmu.de

Supplementary Materials

    • Supplemental Materials (PDF 512 KB)
  • Collapse
  • Expand
  • 1.

    Fendler WP, Reinhardt S, Ilhan H, et al. Preliminary experience with dosimetry, response and patient reported outcome after 177Lu-PSMA-617 therapy for metastatic castration-resistant prostate cancer. Oncotarget 2017;8:35813590.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Rahbar K, Ahmadzadehfar H, Kratochwil C, et al. German multicenter study investigating 177Lu-PSMA-617 radioligand therapy in advanced prostate cancer patients. J Nucl Med 2017;58:8590.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Sartor O, de Bono J, Chi KN, et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med 2021;385:10911103.

  • 4.

    Husereau D, Drummond M, Augustovski F, et al. Consolidated health economic evaluation reporting standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II Good Practices Task Force. Value Health 2022;25:1031.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Centers for Medicare & Medicaid Services. CMS drug spending. Accessed April 28, 2022. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs

    • Search Google Scholar
    • Export Citation
  • 6.

    Centers for Medicare & Medicaid Services. Overview of the Medicare physician fee schedule search. Accessed April 28, 2022. Available at: https://www.cms.gov/medicare/physician-fee-schedule/search/overview

    • Search Google Scholar
    • Export Citation
  • 7.

    Sung WWY, Choi HCW, Luk PHY, et al. A cost-effectiveness analysis of systemic therapy for metastatic hormone-sensitive prostate cancer. Front Oncol 2021;11:627083.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    DerSarkissian M, Xiao Y, Duh MS, et al. Comparing clinical and economic outcomes associated with early initiation of combination therapy of an alpha blocker and dutasteride or finasteride in men with benign prostatic hyperplasia in the United States. J Manag Care Spec Pharm 2016;22:12041214.

    • Search Google Scholar
    • Export Citation
  • 9.

    U.S. Department of Veterans Affairs, Office of Procurement, Acquisition, and Logistics. Pharmaceutical prices. Accessed September 1, 2022. Available at: https://www.va.gov/opal/nac/fss/pharmPrices.asp

    • Search Google Scholar
    • Export Citation
  • 10.

    Drugs.com. Find drugs & conditions. Accessed September 13, 2021. Available at: https://www.drugs.com

  • 11.

    pan-Canadian Oncology Drug Review. Initial economic guidance report: lutetium Lu 177 dotatate (lutathera) for gastroenteropancreatic neuroendocrine tumors. Accessed September 1, 2022. Available at: https://www.cadth.ca/sites/default/files/pcodr/Reviews2019/10142LutetiumLu177dotatateGEP-NET_inEGR_NOREDACT-ABBREV_Post_31May2019_final.pdf

    • Search Google Scholar
    • Export Citation
  • 12.

    Zhang PF, Xie D, Li Q. Cost-effectiveness analysis of cabazitaxel for metastatic castration resistant prostate cancer after docetaxel and androgen-signaling-targeted inhibitor resistance. BMC Cancer 2021;21:35.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Hoverman JR, Mann BB, Phu S, et al. Hospice or hospital: the costs of dying of cancer in the oncology care model. Palliat Med Rep 2020;1:9296.

    • Search Google Scholar
    • Export Citation
  • 14.

    Su D, Wu B, Shi L. Cost-effectiveness of genomic test-directed olaparib for metastatic castration-resistant prostate cancer. Front Pharmacol 2021;11:610601.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

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

  • 16.

    Barqawi YK, Borrego ME, Roberts MH, et al. Cost-effectiveness model of abiraterone plus prednisone, cabazitaxel plus prednisone and enzalutamide for visceral metastatic castration resistant prostate cancer therapy after docetaxel therapy resistance. J Med Econ 2019;22:12021209.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Amdahl J, Diaz J, Park J, et al. Cost-effectiveness of pazopanib compared with sunitinib in metastatic renal cell carcinoma in Canada. Curr Oncol 2016;23:e340354.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Donga P, Bilir P, Valderrama A, et al. Health state utilities among metastatic castrate-resistant prostate cancer patients with and without symptomatic skeletal events [abstract]. Int J Radiat Oncol Biol Phys 2014;90(Suppl 1):Abstract 3259.

    • Search Google Scholar
    • Export Citation
  • 19.

    Sheppard CW. Computer simulation of stochastic processes through model-sampling (Monte Carlo) techniques. FEBS Lett 1969;2(Suppl 1):S1421.

  • 20.

    Pollard ME, Moskowitz AJ, Diefenbach MA, et al. Cost-effectiveness analysis of treatments for metastatic castration resistant prostate cancer. Asian J Urol 2017;4:3743.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Hofman MS, Emmett L, Violet J, et al. TheraP: a randomized phase 2 trial of 177Lu-PSMA-617 theranostic treatment vs cabazitaxel in progressive metastatic castration-resistant prostate cancer (Clinical Trial Protocol ANZUP 1603). BJU Int 2019;124(Suppl 1):513.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Cheung WY, Kornelsen EA, Mittmann N, et al. The economic impact of the transition from branded to generic oncology drugs. Curr Oncol 2019;26:8993.

  • 23.

    Holko P, Kawalec P. Economic evaluation of sipuleucel-T immunotherapy in castration-resistant prostate cancer. Expert Rev Anticancer Ther 2014;14:6373.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Hehakaya C, Moors EHM, Verkooijen HM, et al. 177Lu-PSMA for advanced prostate cancer: are we ready to play big? Eur J Nucl Med Mol Imaging 2021;48:23252328.

    • Search Google Scholar
    • Export Citation
  • 25.

    Leeuwenkamp OR, Smith-Palmer J, Ortiz R, et al. Cost-effectiveness of lutetium [177Lu] oxodotreotide versus best supportive care with octreotide in patients with midgut neuroendocrine tumors in France. J Med Econ 2020;23:15341541.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Palmer J, Leeuwenkamp OR. Cost-effectiveness of lutetium (177Lu) oxodotreotide vs everolimus in gastroenteropancreatic neuroendocrine tumors in Norway and Sweden. World J Clin Cases 2020;8:47934806.

    • Search Google Scholar
    • Export Citation
  • 27.

    Rustgi SD, Oh A, Yang JY, et al. Initiation of somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis. BMC Cancer 2021;21:597.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Smith-Palmer J, Leeuwenkamp OR, Virk J, et al. Lutetium oxodotreotide (177Lu-Dotatate) for the treatment of unresectable or metastatic progressive gastroenteropancreatic neuroendocrine tumors: a cost-effectiveness analysis for Scotland. BMC Cancer 2021;21:10.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    de Feria Cardet RE, Hofman MS, Segard T, et al. Is prostate-specific membrane antigen positron emission tomography/computed tomography imaging cost-effective in prostate cancer: an analysis informed by the proPSMA trial. Eur Urol 2021;79:413418.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Roach PJ, Francis R, Emmett L, et al. The impact of 68Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med 2018;59:8288.

    • Search Google Scholar
    • Export Citation
  • 31.

    Fendler WP, Weber M, Iravani A, et al. Prostate-specific membrane antigen ligand positron emission tomography in men with nonmetastatic castration-resistant prostate cancer. Clin Cancer Res 2019;25:74487454.

    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 994 994 994
PDF Downloads 734 734 734
EPUB Downloads 0 0 0