title: A cost-utility analysis of degarelix in the treatment of advanced hormone-dependent prostate cancer in the United Kingdom.
abstract: OBJECTIVE
  To determine the cost-effectiveness of the treatment of advanced hormone-dependent prostate cancer with degarelix compared to luteinizing hormone-releasing hormone (LHRH) agonists in the UK using the latest available evidence and the model submitted to AWMSG.
  
  
  METHODS
  A cost-effectiveness model was developed from the perspective of the UK National Health Service evaluating monthly injection of degarelix against 3-monthly leuprorelin therapy plus anti-androgen flare cover for the first-line treatment of patients with advanced (locally advanced or metastatic) hormone-dependent prostate cancer. A Markov process model was constructed using the patient population characteristics and efficacy information from the CS21 Phase III clinical trial and associated extension study (CS21A). The intention-to-treat (ITT) population and a high-risk sub-group with a PSA level >20 ng/mL were modeled.
  
  
  RESULTS
  In the base-case analysis using the patient access scheme (PAS) price, degarelix was dominant compared to leuprorelin with cost savings of £3633 in the ITT population and £4310 in the PSA > 20 ng/mL sub-group. The chance of being cost-effective was 95% in the ITT population and 96% in the PSA > 20 ng/mL sub-group at a threshold of £20,000 per quality-adjusted life-year (QALY). In addition, degarelix remained dominant when PSA progression was assumed equal and only the benefits of preventing testosterone flare were taken into account. Treatment with degarelix also remained dominant in both populations when the list price was used. The additional investment required to treat patients with degarelix could be offset in 19 months for the ITT population and 13 months for the PSA > 20 ng/mL population. The model was most sensitive to the hazard ratio assumed for PSA progression between degarelix and leuprorelin and the quality-of-life (utility) of patients receiving palliative care.
  
  
  CONCLUSIONS
  Degarelix is likely to be cost-effective compared to leuprorelin plus anti-androgen flare cover in the first-line treatment of advanced hormone-dependent prostate cancer.
authors.affiliation: BSc, BresMed , Sheffield , UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Lee
authors.forename: Joshua
authors.initials: J
authors.lastname: Porter
authors.forename: Daniel
authors.initials: D
authors.lastname: Gladwell
authors.forename: Nic
authors.initials: N
authors.lastname: Brereton
authors.forename: Sandy K
authors.initials: SK
authors.lastname: Nielsen
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000191:economics* / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors*; D006801:Humans; D016729:Leuprolide / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D009842:Oligopeptides / Q000191:economics* / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000187:drug effects; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009842:Oligopeptides; C431566:acetyl-2-naphthylalanyl-3-chlorophenylalanyl-1-oxohexadecyl-seryl-4-aminophenylalanyl(hydroorotyl)-4-aminophenylalanyl(carbamoyl)-leucyl-ILys-prolyl-alaninamide; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen; D016729:Leuprolide