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

• Auteurs principaux: Bretoni A (Auteur), Ferrario L (Auteur), Foglia E (Auteur)
• Format: Livre
• Publié: Dove Medical Press, 2019-04-01T00:00:00Z.
• Sujets: article
• Accès en ligne: Connect to this object online.
• Notes: 1178-6981
• Keywords: mCRPC; multidimensional assessment; economic evaluation; multicriteria decision analysis; hormonal therapies; MCDA; Medicine (General); R5-920; Therapeutics. Pharmacology; RM1-950
• Source: ClinicoEconomics and Outcomes Research, Vol Volume 11, Pp 283-300 (2019)

Alberto Bretoni, Lucrezia Ferrario, Emanuela FogliaCentre for Health Economics, Social and Health Care Management, LIUC &ndash; Universit&agrave; Cattaneo, Castellanza, ItalyPurpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of na&iuml;ve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting.Methods: In 2017&ndash;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&rsquo; 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 (&euro; 1,056.02 vs &euro; 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&rsquo; perceptions, based on a 7-item Likert scale (ranging from &minus;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&rsquo; 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.Keywords: mCRPC, multidimensional assessment, economic evaluation, decision analysis, hormonal therapies, MCDA