title: [Cost effectiveness of GnRH antagonists in patients with prostate cancer and cardiovascular risk : Comparative analysis against Leuprorelin by the Number Needed to Treat].
abstract: BACKGROUND
  Recent studies suggest that androgen deprivation therapy (ADT) is associated with increased cardiovascular (CV) risk for patients with hormone-sensitive prostate cancer (PCa) and pre-existing CV disease. This risk seems to be different for the gonadotropin-releasing hormone (GnRH) agonists leuprolide and goserelin and GnRH antagonists, whereas the slightly more expensive GnRH antagonist shows a beneficial risk profile. The present study assesses the cost effectiveness of degarelix compared to leuprolide for PCa patients with increased CV risk.
  
  
  METHODS
  This analysis is based on a pooled analysis of six phase III, randomized, controlled trials comparing the GnRH agonists leuprolide and goserelin with the GnRH antagonist degarelix. For the combined endpoint of CV events or death a superiority of degarelix was determined with a Number-Needed-to-Treat of 12. From the perspective of German statutory health insurance, this evaluation estimates and compares the additional drug costs of degarelix treatment to the cost of one (avoided) CV event. The CV event costs were estimated via emergency treatment and transportation, inpatient treatment, and rehabilitation. The difference of these two cost pools divided by 12 yields the average saving per patient and year.
  
  
  RESULTS
  For every 12 PCa patients with CV history that are treated with GnRH antagonists to prevent one CV event, there will be additional drug costs in comparison with leuprolide treatment of € 3111 per year. Costs of € 8447 per year are prevented. Therefore, each patient with a history of CV who is treated with degarelix instead of a leuprolide generates savings of € 445 per patient and year.
  
  
  CONCLUSIONS
  Compared to leuprolide, degarelix is cost effective for patients with increased CV risk.
authors.affiliation: Ecker + Ecker GmbH, Warburgstraße 50, 20354, Hamburg, Deutschland. d.anderson@gmx.de.
authors.forename: D
authors.initials: D
authors.lastname: Anderson
authors.affiliation: Klinik für Urologie, Städtisches Krankenhaus, Kiel, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Lehmann
authors.affiliation: Ecker + Ecker GmbH, Warburgstraße 50, 20354, Hamburg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Ecker
authors.affiliation: Ferring Arzneimittel GmbH, Kiel, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Vosgerau
authors.affiliation: Ferring Arzneimittel GmbH, Kiel, Deutschland.
authors.forename: V
authors.initials: V
authors.lastname: Donatz
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003362:Cost-Benefit Analysis; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D015201:Meta-Analysis as Topic; D009842:Oligopeptides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
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; D016729:Leuprolide
keywords: Androgen deprivation therapy; Cost-effectiveness analysis; Degarelix; Numbers needed to treat; Prostate cancer