Cost-effectiveness analysis of eight first-line treatments for metastatic hormone-sensitive prostate cancer in China

Background The treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has shifted from androgen deprivation therapy (ADT) alone to doublet or triplet regimens building on ADT. However, the cost-effectiveness analysis of first-line treatments for mHSPC in China is uncertain. This study aims to perform a 10-year horizon health economic evaluation to comparatively analyze the cost-effectiveness of eight treatment regimens for mHSPC from the perspective of China’s healthcare system, including (1) ADT alone and ADT plus one of the following: (2) docetaxel, (3) abiraterone, (4) apalutamide, (5) enzalutamide, (6) rezvilutamide, (7) darolutamide and docetaxel, (8) abiraterone and docetaxel. Methods Partitioned survival model was developed to evaluate the cost-effectiveness of eight first-line treatment regimens for mHSPC. Drug costs were primarily extracted from pharmaceutical databases. The key outcomes were quality adjusted life years (QALYs), costs and the incremental cost-effectiveness ratio (ICER). Willingness-to-pay (WTP) threshold was set as three-time China’s gross domestic product (GDP) per capita (US38, 024) per QALY. Results For costs, the 10-year cost estimates ranged from US120, 844 for ADT alone to US216, 294 for darolutamide plus ADT with docetaxel. For clinical effectiveness, enzalutamide plus ADT yielded the highest QALYs (4. 55), while ADT alone gained lowest QALYs (3. 01). For cost-effectiveness, the three treatment regimens of ADT alone, abiraterone plus ADT and enzalutamide plus ADT constituted the cost-effectiveness frontier. Abiraterone plus ADT emerged as the most cost-effective strategy, indicative of an ICER of US17437. 16 per QALY, substantially below WTP threshold. Conclusion Abiraterone plus ADT was likely to be cost-effective for mHSPC treatment at a WTP threshold of three-time per capita GDP per QALY.