Background In combination with prednisone or prednisolone, cabazitaxel is indicated for the treatment of patients with hormone-refractory metastatic prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. Cabazitaxel was evaluated versus mitoxantrone in an open-label randomised phase III trial, the TROPIC study.
Purpose To evaluate the cost-efficacy of cabazitaxel for the treatment of patients with mHRPC previously treated with a docetaxel-containing regimen, using mitoxantrone as a comparator.
Materials and Methods Cabazitaxel and mitoxantrone efficacy and safety data were sourced directly from the TROPIC trial. Two different efficacy parameters were considered: overall survival (OS) and progression free survival (PFS). The costs of the two therapeutic options were calculated based on the direct cost of the drugs, treatment duration and the probability of using granulocyte colony-stimulating factors (filgrastim). This study was conducted from an institutional perspective – the hospital perspective.
Results In the TROPIC trial, the median OS was 15.1 months with cabazitaxel and 12.7 months with mitoxantrone, and median PFS was 2.8 months in the cabazitaxel group and 1.4 months in the mitoxantrone group. Median number of treatment cycles was six for cabazitaxel and four for mitoxantrone. The most frequent clinically significant grade 3/4 adverse events were neutropenia (cabazitaxel (82%) vs. mitoxantrone (58%)). The marginal efficacy of cabazitaxel vs. mitoxantrone is 2.4 months for OS and 1.4 months for PFS. Considering OS as efficacy parameter, the incremental cost-efficacy ratio (ICER) calculated for the two treatments is €147.389. When PFS is considered, the ICER calculated is €248.871.
Conclusions Based on this analysis, the ICERs calculated for cabazitaxel are too high for it to be considered a cost-effective option in the treatment of mHRPC, when compared with mitoxantrone, in patients previously treated with a docetaxel-containing regimen.
No conflict of interest.
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