title: The value of anticancer drugs in metastatic castrate-resistant prostate cancer: economic tools for the community oncologist.
abstract: BACKGROUND
  Community oncologists need a simplified methodology for assessing the value of anticancer drugs. In the United States and Europe, costs of anticancer drug were previously estimated at US$50,000 to >US$100,000 per quality adjusted lifeyear (QALY). The National Institute for Health and Care Excellence in the United Kingdom states that the average cost-effectiveness ratios intervention of >US$50,000 per QALY must be questioned.
  
  
  OBJECTIVE
  To design a drug model to estimate the amount in United States dollars (US$) paid for life-year gain (LYG) and QALY, and to apply that model in the treatment of chemo-naïve and chemo-treated patients with castrate-resistant metastatic prostate cancer (mCRPC).
  
  
  METHODS
  Cost per LYG (cost/LYG) was compared with cost per probability of survival (cost/PoS) calculated as [1.0 minus HR]. Results were expressed in relative values (RV) calculated as US$50,000 or US$100,000 per cost/outcome.
  
  
  RESULTS
  In patients with mCRPC, generic docetaxel demonstrated the lowest cost/LYG (US$26,330), lowest cost/ PoS (US$21,942), and the highest RV (3.80-4.56). Cost/LYG of sipuleucel-T was US$272,195, with an RV of 0.37. Significant variation between cost/LYG and cost/PoS was noted among drugs with borderline survival and HR. In previously treated patients, the cost/LYG of cabazitaxel was US$207,240; of abiraterone, US$194,087; enzalutamide, US$223,500; and radium-223 dichloride, US$230,000, all with RVs <0.5.
  
  
  CONCLUSIONS
  A simplified drug model to weigh cost, survival, and HR with imposed limits on cost/outcome was proposed and applied to patients with mCRPC. The results among that patient population suggested that generic docetaxel had the lowest costs, cost/outcome and the highest RV. Sipuleucel-T, abiraterone, enzalutamide, radium-223 dichloride, and cabazitaxel were overpriced for their values. Drugs with RVs of <0.5 should be scrutinized, costs negotiated, or other drugs considered, and those with RVs of <0.25, rejected.
authors: Hematology/Oncology Section, Department of Medicine, University of California, Irvine, USA. cancerguir@gmail.com.
authors: Helmy M
authors: HM
authors: Guirgis
keywords: CRPC; Survival/HR; abiraterone; cabazitaxel; cost/value; docetaxel; economic model; enzalutamide; radium-223; sipuleucel-T