HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer.

Tytuł:: HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer.
Autorzy:: Bretoni A; Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy.
Ferrario L; Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy.
Foglia E; Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy.
Źródło:: ClinicoEconomics and outcomes research : CEOR [Clinicoecon Outcomes Res] 2019 Apr 17; Vol. 11, pp. 283-300. Date of Electronic Publication: 2019 Apr 17 (Print Publication: 2019).
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Auckland, NZ : Dove Medical Press
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Contributed Indexing:: Keywords: MCDA; decision analysis; economic evaluation; hormonal therapies; mCRPC; multidimensional assessment
Entry Date(s):: Date Created: 20190523 Latest Revision: 20201001
Update Code:: 20240104
PubMed Central ID:: PMC6489625
DOI:: 10.2147/CEOR.S189436
PMID:: 31114269
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Purpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of naïve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting. Methods: In 2017-2018, a Health Technology Assessment was conducted in Italy, considering the National Healthcare Service (NHS) perspective. Data were retrieved from literature evidence, economic evaluations, and qualitative questionnaires, considering the 9 EUnetHTA dimensions, and a final multi-criteria approach. Results: On the basis of mCRPC prevalence and incidence rates in Italy, the analysis considered 11,212 males eligible to either AA+P or ENZA treatments. Both drugs led to an improvement of the patients' overall survival, with respect to the standard of care, composed of docetaxel chemotherapy. However, AA+P showed a higher rate of drug-related moderate adverse events and a monitoring activities incidence superior to ENZA (+70%, p -value=0.00), which led to a major resources absorption (€ 1,056.02 vs € 316.25, p -value=0.00), whereas ENZA showed a better cost-effectiveness average value (CEV: 54,586.12 vs 57,624.15). Economic savings ranging from 1.46% to 1.61% emerged for the NHS, as well as organizational advantages, with fewer minutes required for the mCRPC management (AA+P: 815 mins vs ENZA: 500 mins). According to experts' perceptions, based on a 7-item Likert scale (ranging from -3 to +3), similar results emerged on ethical and social impact (ENZA: 1.35 vs AA+P: 1.48, p -value>0.05), and on legal dimension (ENZA: 0.67 vs AA+P: 0.67, p -value>0.05), since both drugs improved the patients' quality of life and received approval for use. High-level perceptions related to ENZA adoption emerged with regard to equity (ENZA: 0.69 vs AA+P: 0.25, p -value<0.05), since it is cortisone-free. Multi-criteria approach analysis highlighted a higher score of ENZA than comparator (0.79 vs 0.60, p -value=0.00). Conclusion: The evidence-based information underlined the advantages of ENZA and AA+P treatments as therapeutic options for mCRPC patients. In the appraisal phase, the higher score than the comparator suggested ENZA as the preferred treatment for mCRPC.
Competing Interests: The authors report no conflicts of interest in this work.

Erratum in: Clinicoecon Outcomes Res. 2019 Aug 06;11:515. (PMID: 31496768)

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