The Budgetary Impact of Promising Prostate Cancer Drugs


With recent therapeutic advances, the treatment landscape for metastatic castration-resistant prostate cancer is changing rapidly.

Enzalutamide, an oral androgen receptor inhibitor that targets multiple steps within the androgen signaling pathway, represents a substantial advance in the treatment of metastatic castration-resistant prostate cancer (mCRPC), according to a study published in the Journal of Managed Care and Specialty Pharmacy.

Prostate cancer, one of the most costly cancers in the United States, accounted for approximately 25% of all cancers in American men in 2015. An estimated 221,000 men were diagnosed last year, and approximately 27,540 men are estimated to die from prostate cancer in 2015.

Clinical presentation ranges from early, localized disease to advanced, metastatic malignancies. Despite the high incidence of prostate cancer, the majority of patients (> 95%) do not progress to metastatic disease.

Patients with metastases are treated with androgen deprivation therapy to reduce testosterone to castrated levels. However, nearly all patients with metastases become castration resistant about 1-2 years after initiation of hormonal therapy.

Prostate Cancer Treatment

Prostate cancer carries a substantial economic burden. Prostate cancer-related costs totaled an estimated $11.9 billion in 2010 ($13.5 billion in 2015 dollars), making prostate cancer one of the most costly cancers in the United States, according to the study. Mean lifetime prostate cancer-related costs were estimated to total $34,432 per patient in 2004 ($48,963 in 2015 dollars).

With recent therapeutic advances, the treatment landscape for mCRPC is changing rapidly. For patients with advanced mCRPC, first-line systemic therapy options include enzalutamide, abiraterone acetate, and docetaxel, the study noted.

Enzalutamide (Xtandi), an oral androgen receptor inhibitor that targets multiple steps within the androgen signaling pathway, represents an advancement in the treatment of mCRPC. The efficacy and safety of enzalutamide in men with mCRPC were demonstrated in 2 randomized, placebo-controlled, multicenter phase 3 clinical trials.

Economic Impact of Prostate Cancer

Health care decision makers are faced with a growing challenge of managing limited resources while optimizing patient outcomes, especially with regard to oncology products. There is a need for clear, comprehensive information concerning the economic impact of new health technologies.

The researchers estimated the budgetary impact of enzalutamide for the treatment of mCRPC patients who have not received chemotherapy. The model developed for the analysis compared enzalutamide treatment with current treatment practices for the chemotherapy-naïve patient population in accordance with National Comprehensive Cancer Network guidelines.

Comparators included enzalutamide, abiraterone acetate (Zytiga), sipuleucel-T (Provenge), radium Ra 223 dichloride (Xofigo), and docetaxel (Taxotere).

The Cost Impact of Xtandi in Chemotherapy Naïve Patients

In the base case analysis, with 115 chemotherapy-naïve mCRPC patients, this budget impact analysis suggests that the adoption of enzalutamide in chemotherapy-naïve mCRPC patients will have a modest budget impact to a hypothetical 1 million member health plan of $510,641, with a per patient per year cost of $4,426, per person per month cost of $369, and per member per month cost of $0.04.

The costs for enzalutamide were partially offset by moderate adverse event profile and concomitant medication costs as well as lack of additional monitoring requirements. Further research is necessary to validate the total direct costs of mCRPC in the real world.

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