Cost-effectiveness analysis of the addition of metastasis directed therapy to intermittent hormone therapy for oligometastatic prostate cancer
Faculty and Abstracts
Purpose: The treatment landscape for patients with oligometastatic disease has recently been transformed by the emergence and adoption of metastasis-directed therapy (MDT) as a novel paradigm. The recently published phase II EXTEND trial demonstrated that combining MDT with intermittent hormone therapy improved PFS and eugonadal PFS over hormone therapy alone in patients with oligometastatic prostate cancer, although this treatment strategy may be associated with significant costs. This current study aims to evaluate the comparative cost-effectiveness of the addition of MDT to intermittent hormone therapy from a US healthcare sector perspective.
Methodology: The EXTEND trial prostate intermittent hormone therapy basket included men with oligometastatic prostate cancer, with 5 or fewer metastases and treated with 2 or more months of hormone therapy prior to enrollment. These patients were randomized to receive MDT with intermittent hormone therapy versus hormone therapy alone. We will construct a state-transition microsimulation model to simulate patients randomized to the study treatment arms, according to an intention-to-treat principle. Hazard rates of disease progression and death were based on the individual patient data from primary analysis of the EXTEND trial. Inputs for adverse events and quality of life utility weights were derived from the literature and the trial data, if available. We will perform probabilistic sensitivity analysis and estimated costs and quality-adjusted life years (QALYs) over a 5-year time horizon. We will additionally evaluate sensitivity to uncertainty of key model parameters.
Results: We will report estimated costs and QALYs for each treatment arm and will calculate the incremental cost-effectiveness ratio (ICER) of any treatment that is more effective yet more costly. We will report results of sensitivity analyses.
Conclusions: We will evaluate cost-effectiveness of the combined treatment strategy based on established willingness-to-pay thresholds.
