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

Value Health. 2021 Jan;24(1):121-128. doi: 10.1016/j.jval.2020.04.1838. Epub 2020 Sep 11.

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 (Cmin) of abiraterone. Patients with a plasma Cmin 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 Cmin 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 Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin 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.

Keywords: abiraterone; cost-effectiveness; food; prostate cancer; therapeutic drug monitoring.

MeSH terms

  • Abiraterone Acetate / blood
  • Abiraterone Acetate / economics
  • Abiraterone Acetate / therapeutic use*
  • Aged
  • Antineoplastic Agents / blood
  • Antineoplastic Agents / economics
  • Antineoplastic Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Disease-Free Survival
  • Drug Monitoring / economics*
  • Humans
  • Male
  • Markov Chains
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms, Castration-Resistant / drug therapy*
  • Quality-Adjusted Life Years

Substances

  • Antineoplastic Agents
  • Prostate-Specific Antigen
  • Abiraterone Acetate