What question did this study set out to answer?

This analysis aims to evaluate the cost-effectiveness of 177 Lu-PSMA-617 compared to cabazitaxel for treating metastatic castration-resistant prostate cancer.

March 22, 2026

Cost-Effectiveness Analysis of 177 Lu-PSMA-617 Versus Cabazitaxel in Metastatic Castration-Resistant Prostate Cancer from a U.S. Health Care Perspective

Puntos clave

This analysis aims to evaluate the cost-effectiveness of 177Lu-PSMA-617 compared to cabazitaxel for treating metastatic castration-resistant prostate cancer.
Developed a partitioned survival model for a 60-month horizon
Estimated lifetime costs and health outcomes associated with both treatments
Derived overall survival and progression-free survival from the TheraP trial
Applied hazard ratios from the TheraP trial to cabazitaxel outcomes
Utilized published sources for health state utilities, costs, and adverse-event impacts
177Lu-PSMA-617 had an incremental cost-effectiveness ratio of $358,990/QALY
Cost-effectiveness sensitive to overall survival hazard ratio and per-cycle treatment costs
Achieved cost-effectiveness if treatment costs drop to $27,656 or if OS HR improves to 0.76
Probabilistic analyses showed 177Lu-PSMA-617 was cost-effective in 19.7% of cases at a WTP threshold of $200,000/QALY

Resumen

The TheraP trial demonstrated that 177Lu-PSMA-617 improved progression-free survival (PFS) compared with cabazitaxel, with no significant difference in overall survival (OS). However, 177Lu-PSMA-617 was associated with fewer severe adverse events, better patient-reported outcomes, and lower health care utilization rates. In this study, we evaluated the impact of these benefits on the cost-effectiveness of 177Lu-PSMA-617 versus cabazitaxel from a U. S. health care perspective. Methods: A partitioned survival model was developed to estimate lifetime costs and health outcomes associated with 177Lu-PSMA-617 versus cabazitaxel over a 60-mo horizon. OS and PFS associated with177Lu-PSMA-617 were derived from a retrospective cohort, and relative treatment effects (hazard ratios HRs) from the TheraP trial were applied to generate outcomes for patients treated with cabazitaxel. Health state utilities, adverse-event disutilities, and costs were obtained from published sources. Outcomes included total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit at willingness-to-pay (WTP) thresholds up to 200, 000/QALY. Results: In the base case analysis, 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel (incremental cost-effectiveness ratio, 358, 990/QALY). Cost-effectiveness results were most sensitive to the OS HR, the per-cycle cost of 177Lu-PSMA-617, and the per-cycle cost of cabazitaxel. 177Lu-PSMA-617 would become cost-effective if the per-cycle treatment cost was 27, 656 or if the OS HR improved to 0. 76 at a WTP threshold of 200, 000/QALY. Probabilistic analyses found that 177Lu-PSMA-617 was cost-effective in 19. 7% of iterations at a WTP threshold of 200, 000/QALY, 4. 7% at 100, 000/QALY, and 2. 2% at 50, 000/QALY. Conclusion: Although 177Lu-PSMA-617 was not cost-effective compared with cabazitaxel in the base case analysis, it may achieve cost-effectiveness under more favorable assumptions of survival benefit or reduced cost per cycle. Probabilistic analyses further highlighted substantial uncertainty, with a low likelihood of cost-effectiveness.

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