Cost-utility Analysis Methods of Androgen Receptor Targeted Agents for Metastatic Hormone-Sensitive Prostate Cancer: A Systematic Review

As the clinical effectiveness of androgen receptor targeting agents (ARTAs) has been proven, countries worldwide recommend ARTAs treatment to delay the progression of metastatic hormone-sensitive prostate cancer (mHSPC). This study aimed to summarize the methods and data resources by systematically reviewing the cost-utility analysis (CUA) studies of ARTAs in patients with mHSPC. PubMed, Embase and Cochrane Library databases were utilized for literature searches, and the relevant studies were selected with pre-defined inclusion/exclusion criteria according to the PRISMA guideline. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to assess selected studies’ risk-of-bias. Of the 362 publications identified initially, ten eligible studies from six countries were included. All studies were trial-based CUA studies. Ten studies were selected which included eighteen CUAs (eight abiraterone acetate, four apalutamide, and six enzalutamide as interventions, and the comparator was ADT with ARTAs or docetaxel, or ADT alone). Eight studies used Markov models with key health states (mHSPC, mCRPC, death), while the rest were structured as partitioned survival analysis model and descriptive-analytical model, respectively. All the transition probabilities were derived from the pivotal clinical studies. Utility values were calculated by referring to studies that directly measured utility values such as randomized controlled trials or previous literature on economic evaluations or utility, while costs were estimated from real-world data from each country. The reporting quality of studies is valid from 79.2% to 100% (median 95.8%). The results of this study can serve as valid input values for elaborating CUA studies of ARTAs in the future.