$200K Saved With First-Line Docetaxel for Prostate Cancer

Nick Mulcahy

June 12, 2018

CHICAGO — Two systemic drugs for the treatment of newly diagnosed metastatic prostate cancer, which have comparable overall survival benefits, have hugely different costs, according to a new cost-effectiveness modeling analysis.

The patient data for the analysis were obtained from the CHAARTED and LATITUDE studies. In these trials, the systemic therapies, docetaxel (Taxotere, Pfizer) or abiraterone acetate (Zytiga, Janssen), were added to androgen deprivation therapy (ADT).

Both drugs, in combination with ADT, are considered standard of care.

However, in the modeling study, adding docetaxel to ADT increased cost by $12,185, whereas adding abiraterone to ADT increased cost by $208,684, report the study authors, led by Chethan Ramamurthy, MD, a hematology/oncology fellow at Fox Chase Cancer Center in Philadelphia, Pennsylvania.

The new study is the first to compare the cost-effectiveness of the two drugs, which have changed treatment for many men with newly diagnosed prostate cancer. It was presented as a poster here at the American Society of Clinical Oncology 2018 annual meeting.

The investigators measured clinical effectiveness by using progression-free survival quality-adjusted life-years (PFS QALYs). Cost-effectiveness was calculated by use of incremental cost-effectiveness ratios (ICER).

They report that adding docetaxel or abiraterone to ADT improved PFS QALYs by 0.26 and 0.54, respectively; in other words, abiraterone was more effective clinically on this measure.

The ICER for docetaxel vs ADT was $46,519/QALY; it was $705,323/QALY for abiraterone vs docetaxel.

The cost of abiraterone would have to be reduced by 76% for it to fall below a willingness-to-pay threshold of $150,000/QALY, say the investigators.

"Our study compared the cost-effectiveness of these two highly efficacious and generally equivalent therapies and found a tremendous cost difference between them," said Ramamurthy in a press statement.

Ramamurthy also said the two drugs had "very similar overall survival benefits" in this setting.

Medscape Medical News approached a pair of clinicians not involved with the study to get their reactions to the cost disparity.

Bobby Liaw, MD, of the Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai in New York City, said the new findings are not a "big surprise," given that one drug is still on patent.

Liaw said he does not talk about differences in cost-effectiveness between these drugs with patients "unless it is something a patient wants to discuss."

He keeps the conversation to clinical issues, such as mode of administration, side effects, tolerability, duration of treatment, how each agent might affect comorbidities, and drug interactions.

However, Michael Morris, MD, of Memorial Sloan Kettering Cancer Center in New York City, approaches cost differently in the clinic. "We definitely discuss costs with patients. For many patients, there are still significant cost differences between these two standards of care, of which patients are acutely aware."

But Morris also highlighted the importance of the study's positive finding about abiraterone: "The raw cost differential between the two therapies is important, yes. Just as important is the costs per quality-adjusted life-year." The latter, he said, "speaks to the issue of value."

Morris also said that "these costs can be different depending on the health insurance system in place," which the study authors also pointed out.

Liaw emphasized that this study is not the final word on cost with respect to these patients, because "the vast majority...will go on to receive second, third, and further lines of therapy after having received docetaxel or abiraterone in the metastatic hormone sensitive setting.

"It would be helpful to understand the cost-effectiveness of these drugs in the context of patients' overall disease treatment course, rather than during an isolated period," he said.

Medscape Medical News asked Ramamurthy about that issue. He acknowledged that the study was restricted to the period preceding disease progression.

"The amount of time spent...in the frontline setting is much longer than that typically spent in the castration-resistant (next-line) setting. Thus, while some of the cost differences may be attenuated when second-line therapy is taken into account, the magnitude of the cost difference in the front line is going to have an impact on total cost," he answered.

Dr Ramamurthy and Dr Liaw have disclosed no relevant financial relationships. Dr Morris has multiple financial ties to industry but none to Janssen, the makers of arbiraterone.

American Society of Clinical Oncology (ASCO) 2018. Abstract 6514, presented June 2, 2018.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc

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