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    Cost-utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long-term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data

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    Authors
    Clarke, C. S.
    Hunter, R. M.
    Gabrio, A.
    Brawley, C. D.
    Ingleby, F. C.
    Dearnaley, D. P.
    Matheson, D.
    Attard, G.
    Rush, H. L.
    Jones, R. J.
    Cross, W.
    Parker, C.
    Russell, J. M.
    Millman, R.
    Gillessen, Silke
    Malik, Z.
    Lester, J. F.
    Wylie, J.
    Clarke, Noel W
    Parmar, M. K. B.
    Sydes, M. R.
    James, N. D.
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    Affiliation
    Research Department of Primary Care and Population Health, University College London, London
    Issue Date
    2022
    
    Metadata
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    Abstract
    Adding abiraterone acetate (AA) plus prednisolone (P) to standard of care (SOC) improves survival in newly diagnosed advanced prostate cancer (PC) patients starting hormone therapy. Our objective was to determine the value for money to the English National Health Service (NHS) of adding AAP to SOC. We used a decision analytic model to evaluate cost-effectiveness of providing AAP in the English NHS. Between 2011-2014, the STAMPEDE trial recruited 1917 men with high-risk localised, locally advanced, recurrent or metastatic PC starting first-line androgen-deprivation therapy (ADT), and they were randomised to receive SOC plus AAP, or SOC alone. Lifetime costs and quality-adjusted life-years (QALYs) were estimated using STAMPEDE trial data supplemented with literature data where necessary, adjusting for baseline patient and disease characteristics. British National Formulary (BNF) prices (£98/day) were applied for AAP. Costs and outcomes were discounted at 3.5%/year. AAP was not cost-effective. The incremental cost-effectiveness ratio (ICER) was £149,748/QALY gained in the non-metastatic (M0) subgroup, with 2.4% probability of being cost-effective at NICE's £30,000/QALY threshold; and the metastatic (M1) subgroup had an ICER of £47,503/QALY gained, with 12.0% probability of being cost-effective. Scenario analysis suggested AAP could be cost-effective in M1 patients if priced below £62/day, or below £28/day in the M0 subgroup. AAP could dominate SOC in the M0 subgroup with price below £11/day. AAP is effective for non-metastatic and metastatic disease but is not cost-effective when using the BNF price. AAP currently only has UK approval for use in a subset of M1 patients. The actual price currently paid by the English NHS for abiraterone acetate is unknown. Broadening AAP's indication and having a daily cost below the thresholds described above is recommended, given AAP improves survival in both subgroups and its cost-saving potential in M0 subgroup.
    Citation
    Clarke CS, Hunter RM, Gabrio A, Brawley CD, Ingleby FC, Dearnaley DP, et al. Cost-utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long-term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data. Roviello G, editor. Vol. 17, PLOS ONE. Public Library of Science (PLoS); 2022. p. e0269192.
    Journal
    PLoS One
    URI
    http://hdl.handle.net/10541/625353
    DOI
    10.1371/journal.pone.0269192
    PubMed ID
    35653395
    Additional Links
    https://dx.doi.org/10.1371/journal.pone.0269192
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0269192
    Scopus Count
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