Evidence map›Paper›PMID 34672942›Full record

ArticleCanadian Urological Association journal = Journal de l'Association des urologues du Canada2022

A cost-utility analysis of apalutamide for metastatic castrationsensitive prostate cancer.

Ambica Parmar, Narhari Timilshina, Urban Emmenegger, Martin Smoragiewicz, Beate Sander, Shabbir Alibhai, Kelvin K W Chan

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 4 pooled it
0.6field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 4 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Ambica ParmarOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Narhari TimilshinaInstitute of Health Policy, Management and Evaluative Sciences, University of Toronto, Toronto, ON, Canada.
Urban EmmeneggerOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Martin SmoragiewiczOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Beate SanderInstitute of Health Policy, Management and Evaluative Sciences, University of Toronto, Toronto, ON, Canada.
Shabbir AlibhaiInstitute of Health Policy, Management and Evaluative Sciences, University of Toronto, Toronto, ON, Canada.
Kelvin K W ChanOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Health Sciences Centre · CAUniversity of Toronto · CAPrincess Margaret Cancer Centre · CAPublic Health Ontario · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionEarlier application of oral androgen receptor-axis-targeted therapies in patients with metastatic castration-sensitive prostate cancer (mCSPC) has established improvements in overall survival, as compared to androgen deprivation therapy (ADT) alone. Recently, the use of apalutamide plus ADT has demonstrated improvement in mCSPC-related mortality vs. ADT alone, with an acceptable toxicity profile. However, the cost-effectiveness of this therapeutic option remains unknown.

methodsWe used a state-transition model with probabilistic analysis to compare apalutamide plus ADT, as compared to ADT alone, for mCSPC patients over a time horizon of 20 years. Primary outcomes included expected life-years (LY), quality-adjusted life-years (QALY), lifetime cost (2020 Canadian dollars), and incremental cost-effectiveness ratio (ICER). Parameter and model uncertainties were assessed through scenario analyses. Health outcomes and cost were discounted at 1.5%, as per Canadian guidelines.

resultsFor the base-case analysis, expected LY for ADT and apalutamide plus ADT were 4.11 and 5.56, respectively (incremental LY 1.45). Expected QALYs were 3.51 for ADT and 4.84 for apalutamide plus ADT (incremental QALYs 1.33); expected lifetime cost was $36 582 and $255 633, respectively (incremental cost $219 051). ICER for apalutamide plus ADT, as compared to ADT alone, was $164 700/QALY. Through scenario analysis, price reductions ≥50% were required for apalutamide in combination with ADT to be considered cost-effective, at a cost-effectiveness threshold of $100 000/QALY.

conclusionsApalutamide plus ADT is unlikely to be cost-effective from the Canadian healthcare perspective unless there are substantial reductions in the price of apalutamide treatment.

Identifiers

PMID34672942
PMCPMC8923893
OpenAlexW3205678578

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.