An Economic Evaluation of Docetaxel versus Abiraterone or Enzalutamide in Addition to Androgen Deprivation Therapy for the First-Line Treatment of Metastatic Hormone-sensitive Prostate Cancer in Ontario
Bibliographic record
Abstract
Background: Prostate cancer is a leading cause of cancer morbidity and mortality in Canada. Docetaxel, abiraterone, and enzalutamide have demonstrated survival benefits when added to androgen deprivation therapy (ADT); however, they have never been directly compared. Objective: To evaluate the cost-utility of adding docetaxel, abiraterone, or enzalutamide to ADT in newly diagnosed metastatic hormone sensitive prostate cancer (mHPSC). Methods: A partitioned survival model was constructed to estimate total costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) from the public payer perspective. Results: Although the addition of abiraterone or enzalutamide resulted in greater QALY gains compared to docetaxel (0.34 and 0.35 incremental QALYs, respectively), neither drug appeared cost-effective (ICERs $155,317 and $187,290/QALY, respectively). Model results were sensitive to abiraterone and enzalutamide drug costs. Conclusion: Without a substantial reduction in abiraterone or enzalutamide pricing, docetaxel addition to ADT is the preferred strategy in mHSPC treatment from a cost-effectiveness perspective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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 source (direct Gemma or distilled Codex), 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".