ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1680002
This article is part of the Research TopicEconomic Burdens and Efficiency in Cancer CareView all 3 articles
Cost-Effectiveness Analysis of Second-Generation Androgen Receptor Antagonists for The Treatment of Metastatic Hormone-Sensitive Prostate Cancer
Provisionally accepted
- 1Guangdong Pharmaceutical University, Guangzhou, China
- 2The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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Objective: The combination of second-generation androgen receptor (AR) antagonists with androgen deprivation therapy (ADT) has shown good efficacy and safety in advanced prostate cancer. This study aims to evaluate the cost-effectiveness of three second-generation AR antagonists in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC) in China, providing pharmacoeconomic evidence for clinical drug selection. Methods: A Markov model was constructed based on data from the ARCHES, TITAN, and ARANOTE phase III clinical trials, with a 28-day cycle period. Direct medical costs and quality-adjusted life years (QALYs) were simulated over a 15-year horizon. The incremental cost-effectiveness ratio (ICER) was used as the primary outcome, and a willingness-to-pay (WTP) threshold of three times the 2024 per capita GDP of China was set for cost-utility analysis. Sensitivity analysis was conducted to validate the model's influencing factors and the robustness of the results. Results: The cumulative cost of the apalutamide regimen was ¥776,807, resulting in 4.95 QALYs. Compared to apalutamide, the ICER for enzalutamide was ¥643,309/QALY, while for darolutamide, the ICER was -¥40,625/QALY. Conclusion: For Chinese mHSPC patients, darolutamide is the most cost-effective treatment at a WTP threshold of ¥287,391/QALY, followed by apalutamide, with enzalutamide being less favorable.
Keywords: Second-generation AR antagonists, enzalutamide, Apalutamide, Darolutamide, Metastatic prostate cancer, Markov model, Cost-utility analysis
Received: 05 Aug 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Yang, Chen, Huang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yong Chen, puple2000@163.com
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