1780P - The health inequality impact of darolutamide for non-metastatic castration-resistant prostate cancer: A distributional cost-effectiveness analysis

Background

In the backdrop of keener scrutiny of health equity issues, the impact of a new intervention on inequality in health outcomes is increasingly viewed as an element in health technology assessment. Non-Hispanic (NH) Black patients are disproportionally affected by non-metastatic castration-resistant prostate cancer (nmCRPC). Darolutamide is an approved treatment for nmCRPC and was shown to be effective and safe among NH-Black patients in the ARAMIS trial. The objective of this study was to quantify the health inequality impact of darolutamide+ androgen-deprivation therapy (ADT) relative to ADT for nmCRPC in the U.S. by means of a distributional cost-effectiveness analysis.

Methods

With a decision model, the quality-adjusted life years (QALYs) and costs were estimated for NH-White, NH-Black, Asian, and Hispanic patients. The degree of differences in QALYs among these subgroups was expressed with Atkinson relative inequality indices (0 = equal outcomes and 1 = maximum inequality between subgroups) for both strategies. Their difference was defined as the inequality impact of darolutamide among treated patients. Subtracting equally distributed health opportunity costs from the QALY gains with darolutamide facilitated calculation of the overall health inequality impact across population subgroups.

Results

Darolutamide+ADT resulted in an additional 1.04 (95% confidence interval 0.57; 1.49) QALYs per treated patient relative to ADT, with the greatest gain observed among NH-Black patients (1.48 QALYs (0.49; 2.72)). The relative inequality in QALYs among patients reduced by 66%, from an inequality score of 0.032 (0.004; 0.080) with ADT to 0.011 (0.000; 0.049) with darolutamide+ADT. Factoring in health opportunity costs, treatment of eligible nmCRPC patients with darolutamide resulted in the largest net gain in QALYs among the NH-Black population, thereby having a favorable impact on inequalities in quality adjusted life expectancy.

Conclusions

Darolutamide+ADT for the treatment of nmCRPC results in greater health outcomes than ADT, and reduces inequality in health outcomes across subgroups according to race and ethnicity in the U.S.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Bayer Pharmaceuticals.

Disclosure

J. Janssen, T. Flottemesch, I. Brewer, P. Sullivan: Financial Interests, Institutional, Full or part-time Employment, Precision heor was hired by Bayer to perform the research: PRECISIONheor. J. Partridge: Financial Interests, Personal, Full or part-time Employment, Full time employee of Bayer: Bayer Pharmaceuticals.