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EPAD 2017 - Dominik Berthold

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Key treatment options and costs associated
Dominik Berthold, European School of Oncology (ESO)

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EPAD 2017 - Dominik Berthold

  1. 1. Key Treatment Options and Costs associated with Prostate Cancer Dr Dominik Berthold Medical oncology, Lausanne Switzerland & European School of Oncology, Milan Italy
  2. 2. Prostate cancer: Same name but different diseases Incidental prostate cancer at autopsy: > 50% 11% cancer deaths of all male cancers are PC related
  3. 3. Management options for localized PC Watchful waiting Active surveillance Focal therapy • HIFU • Cryotherapy Surgery • open • robotic assisted Radiation therapy • Standard RT • Hypo-fractionation • Brachytherapy • ± Hormones Aim: cure or control at minimal treatment burden
  4. 4. Treatment options for metastatic PC Castration • surgical • medical Chemotherapy • docetaxel • cabazitaxel Hormonal Agents • Abiraterone • Enzalutamide Bone targeted agents • Radium 223 • Zoledronic acid • Denosumab Immune therapy • Sipuleucel T (US only) Aim: maximizing survival and quality of life
  5. 5. Evolution of treatment options for metastatic PC Logo of speaker’s organisation Enzalutamide Abiraterone Abiraterone Denosumab Denosumab Radium 223 Radium 223 Cabazitaxel Cabazitaxel Cabazitaxel Zoledronic acid SipulocelT SipulocelT SipulocelT Mitoxantrone Docetaxel Docetaxel Docetaxel Docetaxel Castration Medical castration Medical castration Medical castration Medical castration Medical castration Medical castration 1941 1980 1996 2004 2010 2011 2012 2017 Rightdrug-righttime-rightpatient
  6. 6. RESERACH Ongoing interventional phase III studies for prostate cancer: 70 Metastatic prostate cancer • 25 Phase III RCT currently recruiting patients • > 15.000 men to be recruited • Uncountable phase I and II studies in immunotherapy and other approaches potentially practice-changing for PC Clinicaltrials.gov 22.9.2017
  7. 7. COSTS Costs for cancer treatment • Drugs • Outpatient care • Inpatient care • Productivity loss • Primary care • Emergency care Costs change rapidly, vary from nation to nation, are difficult to calculate
  8. 8. Costs local treatment $4075 to $6296 open surgery $5058 to $11 806 robotic surgery Treatment costs of prostate cancer in the first year after diagnosis for France, Germany, Italy, Spain and the UK BJU International, 7 JUL 2009 EUROPEAN UROLOGY 65 (2014) 316–324 Costs Surgery
  9. 9. Costs Lancet Oncology, November 2013 Health-care costs prostate cancers per person in European Union countries in 2009
  10. 10. COSTS Drug Price month/ cycle Typical use Total EURO Medical castration 92 4 years 4416 Taxotere 360 6 cycles 2160 Jevatana 3800 6 cycles 22800 Zytiga 3150 6 months 18900 Xtendi 3150 6 months 18900 Xgeva 300 3 years 10800 Xofigo 5000 6 months 30000 Liste de prix et base de remboursement, Belgium 2017
  11. 11. age 62 age 70 age 79 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2016 2017 Surgery 5000,- Relaps: Radiotherapy 5000,- Medical Castration 11000,- Docetaxel Cabazitaxel Radium 223 Abiraterone Enzalutamide Docetaxel -------Denosumab--------- Palliative RT 240.000,- for drugs and supportive care last 4 years of life The total cost of this man with PC was close to 300.000,- over 18 years. Case Report
  12. 12. From: ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe Ann Oncol. 2016;27(8):1423-1443. doi:10.1093/annonc/mdw213 Castrate-resistant prostate cancer: formulary availability and out-of- pocket costs.
  13. 13. Conclusions • The treatment options for prostate cancer are expanding rapidly. • Intensive research will further widen the spectrum of therapeutic options and potentially costs • Health Technology Assessments should be performed on all new technologies in order to provide the base for effective and efficient allocation of resources in prostate cancer services.

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