Cost Considerations for Enzalutamide for Castration-Resistant Prostate Cancer

New Orleans—Prostate cancer is associated with a high economic burden. A study examined the budget impact of adding enzalutamide for treatment of prostate cancer. The study was presented by Ken O’Day, PhD, MBA, and colleagues at the AUA 2015 Annual Meeting.

Enzalutamide was approved by the FDA for the treatment of metastatic castration-resistance prostate cancer (mCRPC). The recommended dose is 160 mg administered orally once daily.

This study estimated the budget impact in chemotherapy-naïve mCRPC patients over a 1-year period. Epidemiological data, including SEER incidence rates, were used to estimate the total number of mCRPC patients in a 1 million member US health plan. Treatment options included in the study were abiraterone acetate, sipuleucel-T, radium-223 dichloride, and docetaxel.

Prescribing Information and pivotal studies for each drug were consulted regarding dosing, administration, mean duration of therapy, and adverse event (AE) rates.

The researchers consulted RedBook and the Centers for Medicare & Medicaid Services (CMS) average sales pricing files for drug pricing. Administration and monitoring were based on the CMS Physician Fee Schedule, and AEs were pulled from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, as well as published literature.

Drug utilization was estimated for each drug before and after adoption of enzalutamide. The researchers estimated per-patient, per-month (PPPM) and per-patient, per-year (PPPY) costs. One-way sensitivity analyses were performed.

The researchers found that adopting enzalutamide in a treatment regimen for a population of 115 mCRPC patients had only a modest annual plan impact of $510,641, with $4426 PPPY and $0.04 PMPM costs. These calculations were based on moderate AEs associated with enzalutamide and a lack of additional required monitoring.

The cost results were related to enzalutamide drug cost, size of the chemotherapy-naïve mCRPC patient population, and enzalutamide adoption rate.

The researchers concluded that further analysis is needed to understand cost per clinical outcome and the relative costs and benefits of the drug’s use.

Source: O’Day K, Bui CN, Flanders S, et al. Budget impact analysis of enzalutamide for treatment of metastatic castration-resistant prostate cancer from a US payer perspective. Abstract of a presentation at the American Urological Association 2015 Annual Meeting, New Orleans, Louisiana, May 18, 2015.

This research was funded by Astellas Medical Scientific Affairs, Inc., and Medivation, Inc.