Cost-effectiveness analysis of leuprorelin acetate atrigel in the treatment of prostate cancer

Abstract

OBJECTIVE This study aimed to evaluate the clinical effectiveness and cost of leuprorelin acetate Atrigel (Eligard®) in prostate cancer treatment and calculate its cost-effectiveness compared with other luteinizing hormone-releasing hormone (LHRH) agonists (leuprolide acetate microsphere [Lucrin®], goserelin [Zoladex LA®], and triptorelin [Decapeptyl®]). METHODS The primary health-related outcome was life-years gained, and effectiveness was measured through the difference between treatment options. Analyses were performed separately for testosterone suppression targets of <20 ng/dL and <50 ng/dL for disease risk groups (intermediate and high risk) and for disease periods (relapse-free, postrelapse, and postdistant metastasis). Only direct treatment costs were used for cost analyses. Resource utilization was estimated according to the National Comprehensive Cancer Network guidelines and expert opinion. RESULTS This study included 173 patients treated with definitive radiotherapy and maximal androgen blockade. The median follow-up duration was 125.37 (range 10.84-214.37) months. The percentages of patients whose testosterone levels decreased to <20 ng/dL and <50 ng/dL were higher with leuprorelin acetate Atrigel. Compared with leuprolide acetate microsphere, goserelin, and triptorelin, Leuprorelin acetate Atrigel provided cost savings of 8386.04 Turkish liras (TL), 3710.79 TL, and 8446.64 TL, respectively, in patients with testosterone levels of <20 ng/dL and 479.41 TL, 1142.13 TL, and 5490.79 TL, respectively, in patients with testosterone levels of <50 ng/dL. Deterministic sensitivity analysis showed that leuprorelin acetate Atrigel was superior to its comparators regarding incremental cost-effectiveness ratios at low-and high-sensitivity margins. CONCLUSION Leuprorelin acetate Atrigel was found to be clinically more effective and cost-saving than other LHRH agonists in the intermediate-and high-risk groups, regardless of testosterone suppression targets.