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Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients

2020; Elsevier BV; Volume: 24; Issue: 1 Linguagem: Inglês

10.1016/j.jval.2020.04.1838

1524-4733

Renske M.T. ten Ham, Merel van Nuland, Rick A. Vreman, Laurens G. de Graaf, Hilde Rosing, Andries M. Bergman, Alwin D. R. Huitema, Jos H. Beijnen, Anke M. Hövels,

Radiopharmaceutical Chemistry and Applications

Abstract Objectives Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (C min ) of abiraterone. Patients with a plasma C min below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone C min in patients with mCRPC. Methods A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone C min followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate C min taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER). Results Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively. Conclusions Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.