HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer
Alberto Bretoni, Lucrezia Ferrario, Emanuela FogliaCentre for Health Economics, Social and Health Care Management, LIUC – Università Cattaneo, Castellanza, ItalyPurpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + predniso...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-04-01
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| Series: | ClinicoEconomics and Outcomes Research |
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| Online Access: | https://www.dovepress.com/hta-and-innovative-treatments-evaluation-the-case-of-metastatic-castra-peer-reviewed-article-CEOR |
| _version_ | 1828427096585666560 |
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| author | Bretoni A Ferrario L Foglia E |
| author_facet | Bretoni A Ferrario L Foglia E |
| author_sort | Bretoni A |
| collection | DOAJ |
| description | Alberto Bretoni, Lucrezia Ferrario, Emanuela FogliaCentre for Health Economics, Social and Health Care Management, LIUC – Università 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 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.Keywords: mCRPC, multidimensional assessment, economic evaluation, decision analysis, hormonal therapies, MCDA |
| first_indexed | 2024-12-10T16:56:19Z |
| format | Article |
| id | doaj.art-8c039c9df7574e4ca36155a5be576eaa |
| institution | Directory Open Access Journal |
| issn | 1178-6981 |
| language | English |
| last_indexed | 2024-12-10T16:56:19Z |
| publishDate | 2019-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | ClinicoEconomics and Outcomes Research |
| spelling | doaj.art-8c039c9df7574e4ca36155a5be576eaa2022-12-22T01:40:43ZengDove Medical PressClinicoEconomics and Outcomes Research1178-69812019-04-01Volume 1128330045145HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancerBretoni AFerrario LFoglia EAlberto Bretoni, Lucrezia Ferrario, Emanuela FogliaCentre for Health Economics, Social and Health Care Management, LIUC – Università 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 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.Keywords: mCRPC, multidimensional assessment, economic evaluation, decision analysis, hormonal therapies, MCDAhttps://www.dovepress.com/hta-and-innovative-treatments-evaluation-the-case-of-metastatic-castra-peer-reviewed-article-CEORmCRPCmultidimensional assessmenteconomic evaluationmulticriteria decision analysishormonal therapiesMCDA |
| spellingShingle | Bretoni A Ferrario L Foglia E HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer ClinicoEconomics and Outcomes Research mCRPC multidimensional assessment economic evaluation multicriteria decision analysis hormonal therapies MCDA |
| title | HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer |
| title_full | HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer |
| title_fullStr | HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer |
| title_full_unstemmed | HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer |
| title_short | HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer |
| title_sort | hta and innovative treatments evaluation the case of metastatic castration resistant prostate cancer |
| topic | mCRPC multidimensional assessment economic evaluation multicriteria decision analysis hormonal therapies MCDA |
| url | https://www.dovepress.com/hta-and-innovative-treatments-evaluation-the-case-of-metastatic-castra-peer-reviewed-article-CEOR |
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