OBJETIVO:

estudiar el costo-utilidad en España de los diferentes fármacos para tratamiento del cáncer de próstata metastásico resistente a la castración (abiraterona, cabazitaxel, mitoxantrona y docetaxel) en pacientes que evolucionaron a un régimen de quimioterapia con docetaxel.

MATERIALES Y MÉTODOS:

estudio descriptivo de corte longitudinal efectuado en pacientes con cáncer de próstata metastásico resistente a la castración. El costo-eficacia incremental de los diferentes fármacos se expresa en euros por años de vida ajustados por calidad para cáncer de próstata metastásico resistente a la castración. Para la estimación de los años de vida ajustados por calidad sólo se tuvieron en cuenta los costos directos y las utilidades se extrajeron de la bibliografía y se obtuvieron mediante estimaciones indirectas. Para la perspectiva del pagador se estimó un horizonte temporal de 18 meses y el índice de precios al consumidor de España, correspondiente a 2014.

RESULTADOS:

cabazitaxel y abiraterona son los tratamientos más efectivos y más costosos. El costo-utilidad incremental de docetaxel, abiraterona, enzalutamida y cabazitaxel, tomando como referencia mitoxantrona, fue -3.581, 41.720, 98.845 y 118.788 euros por años de vida ajustados por calidad, respectivamente. Mitoxantrona es dominado por docetaxel, fármaco tomado como referencia en este estudio.

CONCLUSIONES:

con base en nuestro modelo, abiraterona es un tratamiento costo-efectivo para pacientes con cáncer de próstata metastásico resistente a la castración, enzalutamida y cabazitaxel resultaron opciones no costo-efectivas.

BACKGROUND:

Prostate cancer is the most frequent tumor in men, followed by lung cancer. Pharmacologic treatment in patients with metastatic prostate cancer is palliative and its goal is to increase survival and quality of life, Between 10 and 20% of the patients will develop castration resistance within the first five years, It is recommended in all cases to maintain hormonal blockade associated with a new hormonal maneuver (androgen administration or withdrawal, extratesticular androgen synthesis, etc.) or others, such as chemotherapy.

OBJECT:

To carry out a cost-utility analysis in Spain of the different existing alternatives for the treatment of metastatic castration-resistant prostate cancer in patients with disease progression after a regimen of chemotherapy based on docetaxel.

MATERIALS AND METHODS:

The incremental cost-effectiveness ratio of the different drugs was expressed as euros for qualityadjusted life years in metastatic castration-resistant prostate cancer. For the quality-adjusted life year estimate, only the direct costs were taken into account and the health utilities were retrieved from the literature and obtained through indirect estimates. The perspective of the payer was considered, along with a temporary horizon of 18 months, and the inflation rate in Spain corresponding to costs published tu to 2014.

RESULTS:

Cabazitaxel and abiraterone were the most effective treatments, as well as the most expensive. Using mitoxantrone as the reference, the incremental cost-utility of docetaxel, abiraterone, enzalutamide, and cabazitaxel was -3,581, 41,720, 98,845, 118, 788 euros por quality adjusted life year, respectively. Docetaxel and was dominant in relation to mitoxantrone, the drug used as the reference in our study.

CONCLUSIONS:

Based on our model, abiraterone is a cost-effective treatment in patients with metastatic castration-resistant prostate cancer, whereas enzalutamide and cabazitaxel are not.

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