Cost-effectiveness analysis of neoadjuvant docetaxel plus androgen deprivation therapy before radical prostatectomy in high-risk localized prostate cancer

ObjectiveHigh-risk localized prostate cancer is often associated with a higher risk of disease progression post-surgery. While radical prostatectomy (RP) is a cornerstone treatment, neoadjuvant chemohormonal therapy (CHT) combining docetaxel plus androgen deprivation therapy (ADT) prior to RP has shown promising efficacy in improving survival outcomes. This study aimed to evaluate the economic efficacy of neoadjuvant CHT followed by RP based on the results of CALGB 90203 from the perspective of Chinese healthcare system.MethodsA partitioned survival model with three states: event-free survival (EFS), progressive disease (PD), and death, was constructed. Clinical efficacy data, including overall survival and event-free survival, were obtained from the CALGB 90203 trial. Utility values, costs of drugs, surgery, follow-up, and adverse events were derived from local data and literature. Lifetime costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of neoadjuvant therapy vs. surgery alone per QALY gained were calculated, with a 5% annual discount rate applied. Cost-effectiveness was assessed against a willingness-to-pay (WTP) threshold of $41,859 per QALY. One-way and probabilistic sensitivity analyses were conducted to test model robustness.ResultsCompared with RP alone, the neoadjuvant CHT strategy provided an additional 1.08 QALYs at an incremental cost of $5,663, resulting in an ICER of $5,238 per QALY. The model was most sensitive to changes in health utility values of EFS and PD state. Probabilistic sensitivity analysis indicated a 96.40% probability that neoadjuvant CHT is cost-effective at the defined threshold.ConclusionFrom the Chinese payer's perspective, neoadjuvant CHT prior to radical prostatectomy is a highly cost-effective treatment strategy for patients with high-risk localized prostate cancer even when accounting for the upfront costs and quality-of-life impact associated with treatment-related adverse events.