title: Cost per median overall survival month associated with abiraterone acetate and enzalutamide for treatment of patients with metastatic castration-resistant prostate cancer.
abstract: OBJECTIVE
  To calculate costs per median overall survival (OS) month in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate plus prednisone (AA + P) or enzalutamide.
  
  
  METHODS
  Median treatment duration and median OS data from published Phase 3 clinical trials and prescribing information were used to calculate costs per median OS month based on wholesale acquisition costs (WACs) for patients with mCRPC treated with AA + P or enzalutamide. Sensitivity analyses were performed to understand how variations in treatment duration and treatment-related monitoring recommendations influenced cost per median OS month. Cost-effectiveness estimates of other Phase 3 trial outcomes were also explored: cost per month of chemotherapy avoided and per median radiographic progression-free survival (rPFS) month.
  
  
  RESULTS
  The results demonstrated that AA + P has a lower cost per median OS month than enzalutamide ($3231 vs 4512; 28% reduction), based on the following assumptions: median treatment duration of 14 months for AA + P and 18 months for enzalutamide, median OS of 34.7 months for AA + P and 35.3 months for enzalutamide, and WAC per 30-day supply of $8007.17 for AA + P vs $8847.98 for enzalutamide. Sensitivity analyses showed that accounting for recommended treatment-related monitoring costs or assuming identical treatment durations for AA + P and enzalutamide (18 months) resulted in costs per median OS month 8-27% lower for AA + P than for enzalutamide. Costs per month of chemotherapy avoided were $4448 for AA + P and $5688 for enzalutamide, while costs per month to achieve median rPFS were $6794 for AA + P and $7963 for enzalutamide.
  
  
  CONCLUSIONS
  This cost-effectiveness analysis demonstrated that costs per median OS month, along with costs of other Phase 3 trial outcomes, were lower for AA + P than for enzalutamide. The findings were robust to sensitivity analyses. These results have important implications for population health decision-makers evaluating the relative value of therapies for mCRPC patients.
authors.affiliation: a Groupe d'analyse, Ltée , Montréal , QC , Canada ;
authors.forename: Dominic
authors.initials: D
authors.lastname: Pilon
authors.affiliation: b Janssen Scientific Affairs, LLC , Horsham , PA , USA.
authors.forename: Marykay
authors.initials: M
authors.lastname: Queener
authors.affiliation: a Groupe d'analyse, Ltée , Montréal , QC , Canada ;
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: b Janssen Scientific Affairs, LLC , Horsham , PA , USA.
authors.forename: Lorie A
authors.initials: LA
authors.lastname: Ellis
mesh_terms: D000069501:Abiraterone Acetate / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001549:Benzamides; D017326:Clinical Trials, Phase III as Topic; D003365:Costs and Cost Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009570:Nitriles; D010669:Phenylthiohydantoin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011241:Prednisone / Q000191:economics* / Q000627:therapeutic use; D017430:Prostate-Specific Antigen; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D009570:Nitriles; D010669:Phenylthiohydantoin; C540278:enzalutamide; D017430:Prostate-Specific Antigen; D000069501:Abiraterone Acetate; D011241:Prednisone
keywords: Abiraterone acetate; Cost; Enzalutamide; Metastatic castration-resistant prostate cancer; Overall survival