Addition of Docetaxel to First-line Long-term Hormone Therapy in Prostate Cancer (STAMPEDE): Modelling to Estimate Long-term Survival, Quality-adjusted Survival, and Cost-effectiveness.

Woods BS; Sideris E; Sydes MR; Gannon MR; Parmar MKB; Alzouebi M; Attard G; Birtle AJ; Brock S; Cathomas R; Chakraborti PR; Cook A; Cross WR; Dearnaley DP; Gale J; Gibbs S; Graham JD; Hughes R; Jones RJ; Laing R; Mason MD; Matheson D; McLaren DB; Millman R; O'Sullivan JM; Parikh O; Parker CC; Peedell C; Protheroe A; Ritchie AWS; Robinson A; Russell JM; Simms MS; Srihari NN; Srinivasan R; Staffurth JN; Sundar S; Thalmann GN; Tolan S; Tran ATH; Tsang D; Wagstaff J; James ND; Sculpher MJ

doi:10.1016/j.euo.2018.06.004

Back

Journal article

Addition of Docetaxel to First-line Long-term Hormone Therapy in Prostate Cancer (STAMPEDE): Modelling to Estimate Long-term Survival, Quality-adjusted Survival, and Cost-effectiveness.

Woods BS Centre for Health Economics, University of York, York, UK. Electronic address: beth.woods@york.ac.uk.
Sideris E Centre for Health Economics, University of York, York, UK.
Sydes MR MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
Gannon MR MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
Parmar MKB MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
Alzouebi M Weston Park Hospital, Sheffield, UK.
Attard G The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
Birtle AJ Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK.
Brock S Dorset Cancer Centre, Poole Hospital NHS Foundation Trust, Poole, UK.
Cathomas R Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Kantonsspital Graubünden, Chur, Switzerland.
Chakraborti PR Royal Derby Hospital, Derby, UK.
Cook A Gloucestershire Oncology Centre, Cheltenham, UK.
Cross WR Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Dearnaley DP The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
Gale J Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth, UK.
Gibbs S Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
Graham JD Beacon Centre, Musgrove Park Hospital, Taunton, UK.
Hughes R Mount Vernon Group, Mount Vernon Hospital, Northwood, UK.
Jones RJ University of Glasgow, UK.
Laing R St Luke's Cancer Centre, Royal Surrey NHS Trust, Guildford, UK.
Mason MD School of Medicine, Cardiff University, Cardiff, UK.
Matheson D University of Wolverhampton, Wolverhampton, UK.
McLaren DB Department of Oncology, Western General Hospital, Edinburgh, UK.
Millman R MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
O'Sullivan JM Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.
Parikh O Department of Oncology, East Lancashire Hospitals NHS Trust, Burnley, UK.
Parker CC The Royal Marsden NHS Foundation Trust, London, UK.
Peedell C South Tees NHS Foundation Trust, Middlesbrough, UK.
Protheroe A Department of Oncology, Churchill Hospital, Oxford, UK.
Ritchie AWS Gloucestershire Royal Hospital Foundation Trust, Gloucester, UK.
Robinson A Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK.
Russell JM Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Forth Valley Royal Hospital, Larbert, UK.
Simms MS Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
Srihari NN Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK.
Srinivasan R Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.
Staffurth JN Velindre Cancer Centre, Cardiff and School of Medicine, Cardiff University, Cardiff, UK.
Sundar S University of Nottingham, Nottingham, UK.
Thalmann GN Department of Urology, University Hospital Bern, Bern, Switzerland.
Tolan S Clatterbridge Cancer Centre, Birkenhead, UK.
Tran ATH The Christie NHS Foundation Trust, Manchester, UK.
Tsang D Southend and Basildon Hospitals, Southend, UK.
Wagstaff J Swansea University College of Medicine, Swansea, UK.
James ND Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Sculpher MJ Centre for Health Economics, University of York, York, UK.

2019-06-04

Published in:

European urology oncology. - 2018

Antineoplastic Combined Chemotherapy Protocols

English BACKGROUND
Results from large randomised controlled trials have shown that adding docetaxel to the standard of care (SOC) for men initiating hormone therapy for prostate cancer (PC) prolongs survival for those with metastatic disease and prolongs failure-free survival for those without. To date there has been no formal assessment of whether funding docetaxel in this setting represents an appropriate use of UK National Health Service (NHS) resources.

OBJECTIVE
To assess whether administering docetaxel to men with PC starting long-term hormone therapy is cost-effective in a UK setting.

DESIGN, SETTING, AND PARTICIPANTS
We modelled health outcomes and costs in the UK NHS using data collected within the STAMPEDE trial, which enrolled men with high-risk, locally advanced metastatic or recurrent PC starting first-line hormone therapy.

INTERVENTION
SOC was hormone therapy for ≥2 yr and radiotherapy in some patients. Docetaxel (75mg/m2) was administered alongside SOC for six three-weekly cycles.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The model generated lifetime predictions of costs, changes in survival duration, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).

RESULTS AND LIMITATIONS
The model predicted that docetaxel would extend survival (discounted quality-adjusted survival) by 0.89 yr (0.51) for metastatic PC and 0.78 yr (0.39) for nonmetastatic PC, and would be cost-effective in metastatic PC (ICER £5514/QALY vs SOC) and nonmetastatic PC (higher QALYs, lower costs vs SOC). Docetaxel remained cost-effective in nonmetastatic PC when the assumption of no survival advantage was modelled.

CONCLUSIONS
Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available.

PATIENT SUMMARY
Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body.

Language