Cost-Effectiveness Analysis of Triptorelin, Goserelin, and Leuprolide in the Treatment of Patients With Metastatic Prostate Cancer: A Societal Perspective

Metastatic prostate cancer is the most common malignant cancer and the second leading cause of death due to various types of cancer among men after lung cancer. This study aimed to analyze the cost-effectiveness of triptorelin, goserelin, and leuprolide in the treatment of the patients with metastatic prostate cancer from the societal perspective in Iran in 2020. This is a cost-effectiveness study in which a 20-year Markov transition modeling was applied. In this study, local cost and quality-of-life data of each health state were gathered from cohort of patients. The TreeAge pro 2020 and Microsoft Excel 2016 software were used to simulate cost-effectiveness of each treatment in the long term. The one-way and probabilistic sensitivity analyses were also performed to measure robustness of the model outputs. The findings indicated that the mean costs and utility gained over a 20-year horizon for goserelin, triptorelin, and leuprolide treatments were $ 13 539.13 and 6.365 quality-adjusted life-years (QALY), $ 18 124.75 and 6.658 QALY, and $ 26 006.92 and 6.856 QALY, respectively. Goserelin was considered as a superior treatment option, given the estimated incremental cost-effectiveness ratio. The one-way and probabilistic sensitivity analyses confirmed the robustness of the study outcomes. According to the results of the present study, goserelin was the most effective and cost-effective strategy versus 2 other options. It could be recommended to policy makers of the Iran healthcare system to prioritize it in clinical guidelines and reimbursement policies. •Depending on the progression of the disease, several treatment strategies for prostate cancer are available, including radiotherapy, prostatectomy, freezing prostate tissue, chemotherapy, and hormone. The more advanced the disease is, the less likely the treatment will be successful, and even in some severe cases it could cause mortality. In hormone therapy, synthetic analogs of gonadotropin-releasing hormone medicines, including goserelin, triptorelin, and leuprolide, are widely used.•Despite the high economic burden of the disease in Iran, no economic evaluation has been done on it, and this is the first research carried out on the cost-effectiveness of hormone therapy for metastatic prostate cancer with 3 medicines, including leuprolide, triptorelin, and goserelin, in Iran. Other strengths of the present research are the inclusion of all the costs, including direct medical and nonmedical costs, as well a