Results from large randomised controlled trials have shown that adding docetaxel to the standard of care (SOC) for men initiating hormone therapy for prostate cancer (PC) prolongs survival for those with metastatic disease and prolongs failure-free survival for those without. To date there has been no formal assessment of whether funding docetaxel in this setting represents an appropriate use of UK National Health Service (NHS) resources.
To assess whether administering docetaxel to men with PC starting long-term hormone therapy is cost-effective in a UK setting.
Design, setting, and participants:
We modelled health outcomes and costs in the UK NHS using data collected within the STAMPEDE trial, which enrolled men with high-risk, locally advanced metastatic or recurrent PC starting first-line hormone therapy.
SOC was hormone therapy for ≥2 yr and radiotherapy in some patients. Docetaxel (75 mg/m2) was administered alongside SOC for six three-weekly cycles.
Outcome measurements and statistical analysis:
The model generated lifetime predictions of costs, changes in survival duration, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).
Results and limitations:
The model predicted that docetaxel would extend survival (discounted quality-adjusted survival) by 0.89 yr (0.51) for metastatic PC and 0.78 yr (0.39) for nonmetastatic PC, and would be cost-effective in metastatic PC (ICER £5514/QALY vs SOC) and nonmetastatic PC (higher QALYs, lower costs vs SOC). Docetaxel remained cost-effective in nonmetastatic PC when the assumption of no survival advantage was modelled.
Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available.
Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body. Docetaxel is a cost-effective intervention in patients with metastatic and nonmetastatic prostate cancer starting hormone therapy. Clinicians and National Health Service funding bodies should consider whether the evidence is now sufficiently compelling to support initiating docetaxel in patients with nonmetastatic disease.
Bibliographical noteFunding Information:
Funding/Support and role of the sponsor : This study was supported by the UK Medical Research Council (delegation to Swiss Group for Cancer Clinical Research [SAKK] in Switzerland) grant number MRC_MC_UU_12023/25 and the following funders: Cancer Research UK (grant number CRUK_A12459), Medical Research Council, Astellas, Clovis Oncology, Janssen, Novartis, Pfizer, and Sanofi-Aventis. The sponsors played no direct role in the study.
Financial disclosures: Beth S. Woods certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Beth S. Woods has received payment for consultancy services from Servier Laboratories Ltd. Eleftherios Sideris reports no conflicts of interest at the time the research was conducted but is now an employee of Roche Products Ltd. Matthew R. Sydes reports personal payments and travel expenses from Eli Lilly, personal payments from Sanofi-Genzyme, unrestricted educational grants to his institution from Clovis Oncology, unrestricted educational grants plus drug and distribution costs to his institution from Astellas, Janssen, Novartis, and Pfizer, and unrestricted educational grants plus discounted drug to his institution from Sanofi-Genzyme. Melissa R. Gannon reports educational grants to her institution from Sanofi Aventis, Pfizer, Novartis, Janssen, and Astellas. Mahesh K.B. Parmar reports unrestricted educational grants plus drug and distribution costs to his institution from Astellas, Janssen, Novartis, and Pfizer, unrestricted educational grants to his institution from Clovis Oncology, and unrestricted educational grants plus discounted drug to his institution from Sanofi-Genzyme. Gerhardt Attard reports speaker fees from Sanofi Aventis. Alison J. Birtle reports receiving honoraria from Janssen, Astellas, Sanofi, Bayer, and AstraZeneca. Richard Cathomas reports receiving honoraria from Sanofi, Janssen, Astellas, and Bayer. David P. Dearnaley reports honararia and consultancy fees from Takeda, Amgen, Astellas, Sandoz, and Janssen Pharma, research funding from Cancer Research UK, and a financial interest in abiraterone via the Institute of Cancer Research Rewards to Inventors programme. Malcolm D. Mason reports honoraria from Sanofi Aventis and Janssen. Joe M. O'Sullivan reports honoraria from Sanofi, Janssen, and Bayer. Christopher C. Parker reports honoraria from AAA, Bayer, and Janssen. Narayanan N. Srihari reports travels grants from Janssen, Pfizer, and Aventis. Shaun Tolan reports travel bursaries from Astellas, Janssen, and Sanofi and honoraria from Astellas. John Wagstaff reports consultancy fees from Astellas and Janssen. Nicholas D. James reports receiving grant support, drug supplies and distribution, lecture fees, and advisory board fees from Janssen, Astellas Pharma, and Novartis, grant support, drug supplies and distribution, and lecture fees from Janssen and Pfizer, grant support and drug supplies and distribution from Janssen and Clovis Oncology, and grant support, discounted drug supplies, lecture fees, advisory board fees, and travel assistance from Sanofi-Aventis. Mark J. Sculpher reports consultancy for a number of pharmaceutical companies but none relating to the products considered in this paper. The remaining authors have nothing to disclose.
© 2018 The Authors
Copyright 2019 Elsevier B.V., All rights reserved.
- Cost-effectiveness analysis
- Prostate cancer
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging