Orchiectomy as an alternative to injectable therapies as a tool to improve access to new generation systemic treatments for Advanced Prostate Cancer in Developing Countries

Abstract PURPOSE: The Brazilian Public Health System (BPHS) hosts approximately 71,730 patients with prostate cancer annually for whom androgen deprivation therapy (ADT) is the is the primary treatment for advanced hormone-sensitive prostate cancer (aHSPC) patients. Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assessed the long-term economic impact of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of the ARPI in developing countries. PATIENTS AND METHODS: Data from aHSPC patients (i.e., TxN1M0 ineligible for local treatment or TxNxM1)in the BPHS database were analyzed from 01/01/2011 to 12/31/2021 using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration. RESULTS: Of the 274,519 aHSPC patients who received active treatment during the 11-year study period, 90% (246,683) underwent chemical castration, and 10% (27,836) underwent BSO. The median duration of chemical castration was 28 months. The BPHS spent an estimated total of US$ 665,552,091.40 on chemical castration and US$ 5,939,348.47 on BSO. The costs per patient were US$ 2,698 and US$ 213.37 for chemical castration and BSO, respectively. Hypothetically, if all aHSPC patients had undergone BSO, the total direct cost for the BPHS would have been US$ 42,774,832.20, saving US$ 622,777,259.20 over 11 years. Conclusions: Based on this extensive financial analysis of data from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival, such as ARPIs.