Real-world clinical outcomes and cost estimates of metastatic castration-resistant prostate cancer treatment: does sequencing of taxanes and androgen receptor-targeted agents matter?

Amanda Pereira-Salgado, Angelyn Anton, Fanny Franchini, Robert K. Mahar, Edmond M. Kwan, Shirley Wong, Julia Shapiro, Andrew Weickhardt, Arun A. Azad, Lavinia Spain, Ashray Gunjur, Javier Torres, Phillip Parente, Francis Parnis, Jeffrey Goh, Christopher Steer, Stephen Brown, Peter Gibbs, Ben Tran, Maarten IJzerman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: Health economic outcomes of real-world treatment sequencing of androgen receptor-targeted agents (ARTA) and docetaxel (DOC) remain unclear. Material and Methods: Data from the electronic Castration-resistant Prostate cancer Australian Database (ePAD) were analyzed including median overall survival (mOS) and median time-to-treatment failure (mTTF). Mean total costs (mTC) and incremental cost-effectiveness ratios (ICER) of treatment sequences were estimated using the average sample method and Zhao and Tian estimator. Results: Of 752 men, 441 received ARTA, 194 DOC, and 175 both sequentially. Of participants treated with both, first-line DOC followed by ARTA was the more common sequence (n = 125, 71%). mOS for first-line ARTA was 8.38 years (95% CI: 3.48, not-estimated) vs. 3.29 years (95% CI: 2.92, 4.02) for DOC. mTTF was 15.7 months (95% CI: 14.2, 23.7) for the ARTA-DOC sequence and 18.2 months (95% CI: 16.2, 23.2) for DOC-ARTA. In first-line, ARTA cost an additional $13,244 per mTTF month compared to DOC. In second-line, ARTA cost $6726 per mTTF month. The DOC-ARTA sequence saved $2139 per mTTF compared to ARTA-DOC, though not statistically significant. Conclusion: ICERs show ARTA had improved clinical benefit compared to DOC but at higher cost. There were no significant cost differences between combined sequences.

Original languageEnglish
Pages (from-to)231-239
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Issue number2
Early online date28 Dec 2022
Publication statusPublished - 7 Feb 2023
Externally publishedYes


  • Health economics
  • Metastatic castration-resistant prostate cancer
  • Prostate cancer
  • Time-to-treatment failure
  • Treatment costs
  • Treatment sequences
  • n/a OA procedure

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