Cost Benefit Analysis in Hong Kong Decides Against Adding Abiraterone Plus Prednisone to ADT in Metastatic Hormone Sensitive Prostate Cancer

Abiraterone/prednisone plus ADT has demonstrated significant clinical benefit in that setting

The results of a cost-effectiveness analysis presented at the ESMO Asia 2017 in Singapore, an Annual Congress organised by the European Society for Medical Oncology, revealed that adding abiraterone plus prednisone to androgen deprivation therapy (ADT) for patients with metastatic hormone sensitive prostate cancer cannot be recommended since is not a cost-effective treatment in the Hong Kong setting.

ADT may remain the standard of care in Hong Kong for these patients despite the well documented survival benefit seen with adding abiraterone and prednisone to ADT in patients with metastatic hormone sensitive prostate cancer.

Chi-Leung Chiang and Horace Choi, Department of Clinical Oncology, the University of Hong Kong and the University of Hong Kong – Shenzhen Hospital, Hong Kong, Hong Kong Province cited the LATITUDE trial, which demonstrated abiraterone plus prednisolone in combination with ADT significantly improved overall survival of patients with hormone sensitive metastatic prostate cancer. Professor Chiang, Doctor Choi and a team of investigators conducted this cost-effectiveness analysis evaluating whether this combination treatment is cost effective for institutions in Hong Kong, in addition to providing clinical benefit.

Data from the 1,199 patients with metastatic, castration-sensitive prostate cancer participating in the randomised LATITUDE clinical trial were included in this analysis.

The investigators used a deterministic Markov model with probabilistic sensitivity analysis (PSA) for accounting parameter uncertainty to compare abiraterone plus prednisolone in combination with ADT to ADT in patients with metastases across a 20-year time horizon. The primary outcomes of the analysis were the quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER). The analysis used Hong Kong’s societal perspective and the 3 times the local gross domestic product (GDP) per capita (USD 43,530 / HKD 339,531 in 2016) was used as the threshold of cost-effectiveness.

Major reduction in the current price of abiraterone in Hong Kong needed for this regimen to become cost-effective

It was determined that adding abiraterone/prednisone to ADP would result in an ICER of median 183,003 in US dollars (95% central range [CR] 148,780 to 235,632) or, in Hong Kong dollars, approximately HKD 1,427,425 (95% CR 1,160,480 to 1,837,926) per QALY gained.

Such ICER was more than 4 times of the local gross domestic product (GDP) per capita. As such, abiraterone/prednisone plus ADT was not evaluated to be a cost-effective strategy compared with the ADT standard care strategy currently employed in Hong Kong institutions.

However, the combined strategy of abiraterone/prednisone plus ADT would become more cost-effective with ICER less than 3 times of the GDP per capita should the cost of abiraterone be reduced to approximately 72% of the current price in a Hong Kong public hospital to 3,116 in US dollars (approximately a median of 24,304 in Hong Kong currency) per cycle.

Conclusions

The authors concluded that, even though the survival benefit of adding abiraterone to androgen deprivation therapy is well-documented and Hong Kong has a high global ranking in GDP per capita, adding abiraterone to ADT is not a cost-effective treatment for patients with metastatic hormone sensitive prostate cancer in the Hong Kong setting and cannot be recommended.

Disclosure

No external funding was reported in this study.

Reference

261O – Chiang CL, Choi HC, et al. Cost-effectiveness analysis of additional Abiraterone for hormone-sensitive metastatic prostatic cancer treated with androgen deprivation therapy (ADT).