Addition of docetaxel to first-line long-term hormone therapy in prostate cancer (STAMPEDE): modelling to estimate long-term survival, quality-adjusted survival, and cost-effectiveness

Woods, B. S. et al. (2018) Addition of docetaxel to first-line long-term hormone therapy in prostate cancer (STAMPEDE): modelling to estimate long-term survival, quality-adjusted survival, and cost-effectiveness. European Urology Oncology, 1(6), pp. 449-458. (doi: 10.1016/j.euo.2018.06.004) (PMID:31158087) (PMCID:PMC6692495)

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Background: 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. Objective: 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. Intervention: 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. Conclusions: 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. Patient summary: 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.

Item Type:Articles
Additional Information: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.
Keywords:Cost-effectiveness analysis, docetaxel, prostate cancer.
Glasgow Author(s) Enlighten ID:Jones, Professor Robert
Authors: Woods, B. S., Sideris, E., Sydes, M. R., Gannon, M. R., Parmar, M. K.B., Alzouebi, M., Attard, G., Birtle, A. J., Brock, S., Cathomas, R., Chakraborti, P. R., Cook, A., Cross, W. R., Dearnaley, D. P., Gale, J., Gibbs, S., Graham, J. D., Hughes, R., Jones, R. J., Laing, R., Mason, M. D., Matheson, D., McLaren, D. B., Millman, R., O'Sullivan, J. M., Parikh, O., Parker, C. C., Peedell, C., Protheroe, A., Ritchie, A. W.S., Robinson, A., Russell, J. M., Simms, M. S., Srihari, N. N., Srinivasan, R., Staffurth, J. N., Sundar, S., Thalmann, G. N., Tolan, S., Tran, A. T.H., Tsang, D., Wagstaff, J., James, N. D., and Sculpher, M. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:European Urology Oncology
ISSN (Online):2588-9311
Published Online:14 September 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Urology Oncology 1(6):449-458
Publisher Policy:Reproduced under a Creative Commons License

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