Cost-effectiveness of enzalutamide with androgen-deprivation therapy (ADT) versus ADT alone for the treatment of high-risk biochemically recurrent non-metastatic castration-sensitive prostate cancer in Canada
Bibliographic record
Abstract
AIM: The EMBARK (NCT02319837) trial demonstrated that enzalutamide with androgen-deprivation therapy (ADT; enzalutamide combination) or without ADT (enzalutamide monotherapy) significantly improved metastasis-free survival compared with ADT alone in high-risk biochemically recurrent (BCR) non-metastatic castration-sensitive prostate cancer (nmCSPC; also known as non-metastatic hormone-sensitive prostate cancer [nmHSPC]). No new safety signals were observed during the trial. The findings of EMBARK led to Health Canada's approval of enzalutamide for this patient population. The aim of this analysis was to assess the cost-effectiveness of enzalutamide combination versus ADT alone in patients with high-risk BCR nmCSPC from the Canadian payer's perspective. MATERIAL AND METHODS: A semi-Markov model was created to represent the treatment and disease progression of patients with high-risk BCR nmCSPC over a 30-year horizon. Costs and outcomes were discounted at 1.5% annually. Treatment effects for high-risk BCR nmCSPC were informed by data from the EMBARK trial. Life-years (LYs), quality-adjusted life-years (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) were estimated for enzalutamide combination and ADT alone. A one-way sensitivity analysis (OWSA) and scenario analyses were conducted to assess the robustness of results. RESULTS: In the base-case deterministic analysis over the modeled time horizon, enzalutamide combination accumulated 11.85 LYs and 8.96 QALYs versus 8.75 LYs and 6.24 QALYs for ADT alone. The total cost for enzalutamide combination was Canadian dollars (CAD) 166,199, compared with CAD 95,146 for ADT alone. When combining cost and clinical outcome data, enzalutamide combination was associated with an ICER of CAD 26,129 per QALY gained. The OWSA and scenario analysis results were consistent with the base-case results. CONCLUSION: The study findings suggest that enzalutamide combination was associated with an ICER of CAD 26,129 per QALY gained, which is within the standard Canadian thresholds for willingness-to-pay (i.e. <CAD 50,000 per QALY gained), making enzalutamide combination a preferred treatment option for patients with high-risk BCR nmCSPC in Canada.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".