cancerbiology-4-1082.pdf - Central Bringing Excellence in Open Access Journal of Cancer Biology Research Short Communication*Corresponding author Costs

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Central Journal of Cancer Biology & Research Cite this article: Guirgis HM (2016) Costs and Values of Anticancer Drugs in Prostate Cancer: Drug Innovations versus Generics. J Cancer Biol Res 4(2): 1082. *Corresponding author Helmy M. Guirgis, University of California, 24806 Sea Crest Dr, Dana Point CA 92620, USA, Tel: 949-306-7157; Submitted: 01 April 2016 Accepted: 21 April 2016 Published: 22 April 2016 Copyright © 2016 Guirgis OPEN ACCESS Keywords Prostate cancer Docetaxel Drug innovations Short Communication Costs and Values of Anticancer Drugs in Prostate Cancer: Drug Innovations versus Generics Helmy M. Guirgis* University of California, USA Abstract Background: California and Ohio are considering legislative measures to reduce prescription drug prices. Objectives : 1- Design a grading system to control costs and improve transparency of anticancer drugs. 2- Weigh costs and values in relative values (RV) in metastatic prostate cancer (mPC) Methods : Updated overall survival (OS), hazard ratios (HR) and dosage were utilized. C osts of 1-day of added OS were calculated. The 1-year-cost (yC) were graded (gr) A < 50,000, B $50,000 to $75,000, C > $7,500 to $100,000 and D > $100,000. The yC was divided by (1.0 –HR) and compared with cost/life-year gain (C/LYG). RV were computed as $50,000 or $100,000/C/LYG depending on lack vs. maintenance/improvement of quality of life (qol). Grade D was assigned to <0.20, C: 0.20 - <0.35, B: 0.35- 0.50 and A: > 0.50. Results: Costs, values and RV of generic docetaxel demonstrated A/gr. Cabazitaxel yC was $ 52,734 with B/gr and enzalutamide $108,348 with D/gr. In chemo-treated patients, RV of cabazitaxel was 0.19/D, abiraterone 0.39/B, enzalutamide 0.37/B and radium-223 0.39/B. In chemo-naïve, enzalutamide RV was 0.17/D. All drugs demonstrated wide differences between C/(1.0-HR) and C/LYG. The 2 values of radium-223 however were superimposed at the reported OS and HR. Conclusions: Docetaxel remains the most cost-effective drug in mPC management. The lowest values were demonstrated by enzalutamide in chemo-naive patients. Decisions based on costs without value consideration were misleading. Radium-223 demonstrated superimposed C/LYG and C/ (1.0- HR). The wide value discrepancy observed with other drugs suggests parallel use of survival and HR and warrants further investigation. ABBREVIATIONS CRPC: Castrate-Resistant Prostate Cancer; CN: Chemo-Naïve; CT: Chemo-Treated; CI: Confidence Interval; C: Cost; C/LYG: Cost/Life-Year Gain; dC: Cost Of 1-Day Of Added Overall Survival Over Control; D: Day; GR: Grade; HR: Hazard Ratio; HS: Hormone Sensitive; IV: Intravenous; M: Metastatic; MG: Milligram; M: Month; RV: Relative Value; Y: Year INTRODUCTION Docetaxel has been the backbone of prostate cancer management since 2004 [1]. Over the last 10 years cabazitaxel [2], sipuleucel-T [3,4], abiraterone [5,6], enzalutamide [7,8] and radium-223 dichloride [9] were developed. These drugs demonstrated significant prolongation of overall survival (OS) with documented safety in metastatic castrate-resistant prostate cancer (CRPC). The high costs (C) however restricted affordability [10]. Legislative measures are being contemplated in California and Ohio to reduce prescription drug prices. The American and
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  • Winter '16
  • Marie Troya
  • Management, Chemotherapy, Prostate cancer, Metastasis, Docetaxel

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