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Cost–Utility Analysis of Darolutamide Combined with Androgen Deprivation Therapy for Patients with High-Risk Non-Metastatic Castration-Resistant Prostate Cancer in China

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Abstract

Introduction

The increasing incidence of prostate cancer (PC) in China leads to a significant disease burden. Although three novel androgen inhibitors (darolutamide, apalutamide, and enzalutamide) have been approved for patients with high-risk non-metastatic castration-resistant prostate cancer (nmCRPC), the economic evaluation of these novel treatments in China remains unknown. In this study, we aimed to evaluate the cost–utility of darolutamide combined with androgen deprivation therapy (ADT), comparing with apalutamide + ADT and enzalutamide + ADT, in patients with high-risk nmCRPC from a healthcare system perspective in China.

Methods

A partitioned survival model was developed to capture time spent by patients in three health states: nmCRPC, metastatic CRPC (mCRPC), and death. Clinical outcomes from the ARAMIS, PROSPER, and SPARTAN studies were obtained. In the absence of head-to-head studies, indirect treatment comparisons were conducted to capture the comparative effectiveness between darolutamide + ADT, apalutamide + ADT, and enzalutamide + ADT. The prices of apalutamide and enzalutamide were assumed to be the same as the initial launch price of darolutamide, since post-negotiation prices after national reimbursement drug list (NRDL) inclusion remain confidential. Other health resources costs, baseline characteristics, treatment patterns, and utility were collected through literature or clinical expert interviews. Selected sensitivity analyses were also performed.

Results

For a 20-year time horizon, darolutamide + ADT was associated with lower cost per quality-adjusted life years (QALYs) than apalutamide + ADT and enzalutamide + ADT (202,897 Chinese yuan (CNY)/QALY vs. 228,998 CNY/QALY and 221,409 CNY/QALY, respectively) (exchange rate, 1 USD = 6.7871 CNY). Darolutamide + ADT had better health outcomes and lower total costs compared to both apalutamide + ADT (+ 0.22 QALYs and − 72,818 CNY) and enzalutamide + ADT (+ 0.09 QALYs and − 67,451 CNY). Across the modelled sensitivity analyses (including hazard ratios and drug costs), darolutamide + ADT remained dominant or cost-effective.

Conclusions

This economic evaluation suggested that, in comparison with apalutamide + ADT and enzalutamide + ADT, darolutamide + ADT was a dominant or cost-effective treatment option for patients with high-risk nmCRPC in China.

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Acknowledgements

The authors gratefully acknowledge the participation of Yanjun Liu, Wenni Li, Weijia Lu (resigned employees of IQVIA) in assisting literature review, data collection and data analysis, and Yihan Liao from Real World Solutions, IQVIA China in assisting manuscript Proofreading.

Funding

Sponsorship for this study, and Rapid Service Fee were funded by Bayer Healthcare Company Ltd. Funding was not contingent upon publication of this article.

Author Contributions

Shanlian Hu contributed to main conceptual ideas and proof outline. Jian Ming and Yuxia Wu developed the model, performed the computations, interpreted results and wrote manuscript. Rong Han, Xing Xu and Reg Waldeck contributed to the data acquisition. All authors provided critical feedback and helped shape the manuscript, and approved the final version.

Disclosures

Jian Ming and Yuxia Wu are employees of Real World Solutions, IQVIA China. Rong Han, Xing Xu, Reg Waldeck are employees of the Bayer Healthcare Company Ltd. Shanlian Hu has nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Authors had full permissions to access/use the data that was used in this economic evaluation.

Data Availability

All data generated or analyzed during this study are included in this published article or as supplementary information files.

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Author notes

  1. Jian Ming and Yuxia Wu are regarded as co-first authors.

Authors and Affiliations

  1. Real World Solutions, IQVIA China, Shanghai, China

    Jian Ming & Yuxia Wu

  2. Medical Affairs, Pharmaceuticals, Bayer Healthcare Company Ltd, Beijing, China

    Rong Han & Xing Xu

  3. Bayer Healthcare Pharmaceuticals, 100 Bayer Blvd, Whippany, NJ, USA

    Reg Waldeck

  4. School of Public Health, Fudan University, Shanghai, China

    Jian Ming & Shanlian Hu

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Ming, J., Wu, Y., Han, R. et al. Cost–Utility Analysis of Darolutamide Combined with Androgen Deprivation Therapy for Patients with High-Risk Non-Metastatic Castration-Resistant Prostate Cancer in China. Adv Ther 40, 1087–1103 (2023). https://doi.org/10.1007/s12325-022-02389-7

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