DOCETAXEL FOR PROSTATE CANCER

A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer

Background

This systematic review examined the clinical and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for metastatic hormone-refractory prostate cancer (mHRPC). Randomised controlled trials comparing docetaxel or mitoxantrone, in combination with prednisone or prednisolone, with other chemotherapy regimens, active supportive care or placebo to treat patients with mHRPC were included.

Findings

The evidence demonstrates that docetaxel plus prednisone is superior to mitoxantrone plus prednisone, in terms of overall survival, quality of life, pain, and PSA decline. Docetaxel plus prednisone seems to be superior to corticosteroids alone in terms of overall survival. However, this is based on an indirect comparison; therefore, the results need to be interpreted with some caution. Our review of the data suggests that docetaxel plus prednisone seems to be the most effective treatment for men with mHRPC. The results from the Assessment Group cost-effectiveness model suggest that treatment with docetaxel plus prednisone/prednisolone is cost-effective in patients with mHRPC as long as the health service is willing to pay £33,000 per additional QALY. Sensitivity analysis demonstrates the robustness of the estimate of cost-effectiveness to these variations.

Conducted by: R Collins1, E Fenwick2, R Trowman1, R Perard2, G Norman1, K Light1, A Birtle3, S Palmer2, R Riemsma1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics; 3. Rosemere Cancer Centre, Royal Preston Hospital, UK

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal Guidance 101: Docetaxel for the treatment of hormone refractory prostate cancer. London: National Institute for Clinical Excellence; 2002

Publications

Collins R, Fenwick E, Trowman R, Perard R, Norman G, Light K, Birtle A, Palmer S, Riemsma R. A systematic review and economic model of the effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer. Health Technol Assess. 2007;11(2): 1-198

Collins R, Trowman R, Norman G, Light K, Birtle A, Fenwick E, Palmer S, Riemsma R. A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer. Br J Cancer. 2006;95 (4):457-62

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process