Addition of Docetaxel to Androgen Deprivation Therapy Improves Survival Outcomes and is Cost-Effective in Metastatic Prostate Cancer

9 Oct, 19

Introduction

The Chinese and western guidelines recommend androgen deprivation therapy (ADT) and addition of an antiandrogen to AD, referred to as maximum androgen blockade (MAB) as the primary systemic treatment for metastatic prostate cancer. recent evidence has demonstrated improved survival outcomes with the addition of docetaxel to ADT (Doc-ADT) in metastatic hormone-sensitive prostate cncer (mHSPC). In China, Doc-ADT, MAB and ADT alone therapies are used for the treatment of advanced prostate cancer. However, there are no studies that have compared the clinical efficacies and cost-effectiveness of these therapies in China.

Aim

The clinical efficacy of Doc-ADT, MAB and ADT-alone has been assessed using network meta-analysis (NMA) and the cost-effectiveness was determined using cost-effectiveness analysis (CEA) in patients with mHSPC in China.

Method

Study Design

Network meta-analysis
A total of 9 randomized clinical trials with 5168 mHSPC patients were included
18% received Doc-ADT (n=951), 28% received MAB (n=1462) and 53% received ADT alone (n=2755)

Endpoints

Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS)
Incremental cost-effectiveness ratio

Results

The comparison between HRs of OS and PFS are shown in figure 1.

Figure 1. Comparative HRs of OS and PFS

HRs of OS and PFS were 0.782 and 0.628 for Doc—ADT vs ADT alone
HRs of OS and PFS was 0.897 and 0.824 for MAB vs ADT-alone
The results of the sensitivity analyses revealed that the probability of Doc-ADT being the most effective treatment was 96% and 100% for OS and PFS respectively
Doc-ADT, MAB and ADT-alone were associated with 5.03, 4.44 and 4.02 quality-adjusted life year (QALY) at an average cost of Chinese yuan (CNY) 424342, 384557 and 326771 respectively per patient
Doc-ADT was cost effective with an ICER of CNY 96,848 and CNY 67,758 per QALY gained compared with MAB and ADT-alone respectively

Conclusion

The survival outcomes associated with addition of docetaxel to androgen deprivation therapy (Doc-ADT) were superior compared to maximum androgen-blockade (MAB) and ADT-alone in the treatment of patients with metastatic hormone-sensitive prostate cancer in China.
Doc-ADT also was the most cost-effective treatment.

J Comp Eff Res. 2019; 8(11):865-877.