Objective  To evaluate the cost-effectiveness of enzalutamide in the treatment of metastatic prostate cancer from the perspective of healthcare in China.

Methods  Based on the published phase Ⅲ randomized controlled trial (ENZAMET), the disease process of metastatic prostate cancer was classified into three states: progression-free survival, progression survival and death, and the model period was defined as 28 days, and the study period was lifelong, and a Markov model was established to evaluate the cost-effectiveness of the treatment of enzalutamide versus standard antiandrogen drugs in metastatic prostate cancer. Setting the willingness-to-pay (WTP) threshold at 3 times our 2022 gross domestic product (GDP) per capita and the robustness of the model analysis was verified by sensitivity analysis.

Results  Compared to the control group standard antiandrogen therapy, the incremental effect of enzalutamide was 0.92 quality-adjusted life years (QALYs), the incremental cost was 311 863.30 yuan, and the incremental cost-effectiveness ratio (ICER) was 338 981.85 yuan/QALY, which was higher than WTP threshold (257 094 yuan/QALY). The results of univariate sensitivity analyses showed that the total cost of the enzalutamide group, the PFS utility value, the cost of the PD status of enzalutamide group, and the unit price of enzalutamide had a greater impact on the model results. The results of the probabilistic sensitivity analysis suggested that the enzalutamide treatment regimen was not economical within the willingness-to-pay threshold of 3 times our 2022 GDP per capita.

Conclusion  Compared with the standard anti-androgen drugs, enzalutamide does not offer a cost-effectiveness advantage in the treatment of metastatic prostate cancer.

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