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ФАРМАКОЭКОНОМИЧЕСКОЕ ИССЛЕДОВАНИЕ ПРИМЕНЕНИЯ ЭНЗАЛУТАМИДА, АБИРАТЕРОНА И КАБАЗИТАКСЕЛА ПОСЛЕ ХИМИОТЕРАПИИ У ПАЦИЕНТОВ С МЕТАСТАТИЧЕСКИМ КАСТРАЦИОННО-РЕЗИСТЕНТНЫМ РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ
Enzalutamide, abiraterone plus prednisone and cabazitaxel plus prednisone (hereafter referred to as abiraterone and cabazitaxel, respectively) are ap- proved for the post-chemotherapy treatment of metastatic castration-resistant prostate cancer (mCRPC) in Russia. Currently, none of these treatments are included in the Government Drug Reimbursement Program (GDRP).
The aim of this pharmacoeconomic evaluation is to comapre enzalutamide, abiraterone and cabazitaxel used after chemotherapy in patients with mCRPC from the Russian healthcare system perspective.
Materials and methods. Based on data from clinical trials - AFFIRM (enzalutamide), COU-AA-301 (abiraterone) and TROPIC (cabazitaxel) – and indirect comparisons of considered drugs, we proposed an mCRPC Markov chain model and calculated medical costs associated with three options. We used the 5-year time horizon as proposed by the national guidelines for pharmacoeconomic research. Budget impact, cost-effectiveness and cost-utility analyses were conducted.
Results: Use of enzalutamide, abiraterone and cabazitaxel resulted in 1.04, 0.94 and 0.96 quality-adjusted life years, respectively. Monthly medication costs for enzalutamide were 183 550,71 RUB per patient, 15% less than for abiraterone and 49% less than for cabazitaxel. Five-year total medical costs were 3 330 982 RUB, 3 331 998 RUB and 4 434 624 RUB per patient for enzalutamide, abiraterone and cabazitaxel, respectively. The smaller differ- ence in total medical costs resulted from longer progression-free survival on enzalutamide compared to abiraterone or cabazitaxel. If included in GDRP, enzalutamide results in the lowest budget impact: 6 524,6 RUB million, compared to 6 526,6 RUB million for abiraterone and 8 688,4 RUB million for cabazitaxel.
Conclusions: Enzalutamide is more effective compared to abiraterone and cabazitaxel and requires the same or less additional budget expenditure in Russia.