Cost-Effectiveness Analysis of LHR Agonists in the Treatment of Metastatic Prostate Cancer in Italy

Objectives: Luteinizing hormone-releasing hormone (LHRH) agonists represent one of the main cost factors in the management of patients with metastatic prostate cancer. We compared the cost-effectiveness of the five different 3-month formulations of LHRH agonists currently available for advanced prostate cancer in Italy, because these differ both in their capacity to suppress testosterone & in their acquisition costs. Methods: A probabilistic, patient-level simulation model was developed to compare the cost-effectiveness, from the perspective of the Italian National Health Service (INNS), of leuprorelin 11.25 mg & 22.5 mg, triptorelin 11.25 mg, buserelin 9.9 mg, & goserelin 10.8 mg. The model incorporated testosterone-dependent progression-free & cancer-specific survival functions, LHRH agonist effectiveness data, & national costs & tariffs. Cox's proportional hazard models were used to compute total & progression-free survival functions based on clinical data from 129 patients with metastatic prostate cancer treated in an Italian center. Bayesian random effects models were employed to summarize evidence from published literature on testosterone suppression obtained with the available LHRH agonists. Results: Estimated total survival was b5 years, with a maximum difference between treatment options of -2 months. There was a mean difference of almost .2,500 in lifetime total costs between the least costly option (leuprorelin 22.5 mg) & the most expensive (goserelin). In the incremental cost-effectiveness analysis, leuprorelin 22.5 mg dominated all alternatives except buserelin, which had an incremental cost-effectiveness ratio versus leuprorelin 22.5 mg of -12,000 per life-month gained. Conclusions: Based on modelling with meta-analysis of comparative survival data, leuprorelin 22.5 mg was the most cost-effective treatment of the available depot formulation LHRH agonists. Adapted from the source document.