Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries
PURPOSEThe Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2024-11-01
|
| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO-24-00319 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846167374747664384 |
|---|---|
| author | Fernando Sabino Marques Monteiro Andre Deeke Sasse Denizar Vianna Araujo Rana R. McKay Karine Martins da Trindade Andrey Soares João Ricardo Alves Douglas Andreas Valverde Diogo Assed Bastos Nicholas D. James Daniel Herchenhorn |
| author_facet | Fernando Sabino Marques Monteiro Andre Deeke Sasse Denizar Vianna Araujo Rana R. McKay Karine Martins da Trindade Andrey Soares João Ricardo Alves Douglas Andreas Valverde Diogo Assed Bastos Nicholas D. James Daniel Herchenhorn |
| author_sort | Fernando Sabino Marques Monteiro |
| collection | DOAJ |
| description | PURPOSEThe Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries.PATIENTS AND METHODSData of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration.RESULTSOf the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients.CONCLUSIONOn the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs. |
| format | Article |
| id | doaj-art-f2e2af4666c044f48e267d99963457e6 |
| institution | Kabale University |
| issn | 2687-8941 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj-art-f2e2af4666c044f48e267d99963457e62024-11-14T21:01:04ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412024-11-011010.1200/GO-24-00319Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing CountriesFernando Sabino Marques Monteiro0Andre Deeke Sasse1Denizar Vianna Araujo2Rana R. McKay3Karine Martins da Trindade4Andrey Soares5João Ricardo Alves6Douglas Andreas Valverde7Diogo Assed Bastos8Nicholas D. James9Daniel Herchenhorn10Latin American Cooperative Oncology Group—LACOG, Porto Alegre, BrazilGrupo SONHE, Campinas, BrazilMedical School at the State University of Rio de Janeiro, Rio de Janeiro, BrazilUniversity of California San Diego, La Jolla, CALatin American Cooperative Oncology Group—LACOG, Porto Alegre, BrazilLatin American Cooperative Oncology Group—LACOG, Porto Alegre, BrazilHospital de Base do Distrito Federal, Brasilia, BrazilTechtrials Pesquisa e Tecnologia Ltda, São Paulo, BrazilLatin American Cooperative Oncology Group—LACOG, Porto Alegre, BrazilInstitute of Cancer Research, London, United KingdomLatin American Cooperative Oncology Group—LACOG, Porto Alegre, BrazilPURPOSEThe Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries.PATIENTS AND METHODSData of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration.RESULTSOf the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients.CONCLUSIONOn the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.https://ascopubs.org/doi/10.1200/GO-24-00319 |
| spellingShingle | Fernando Sabino Marques Monteiro Andre Deeke Sasse Denizar Vianna Araujo Rana R. McKay Karine Martins da Trindade Andrey Soares João Ricardo Alves Douglas Andreas Valverde Diogo Assed Bastos Nicholas D. James Daniel Herchenhorn Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries JCO Global Oncology |
| title | Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries |
| title_full | Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries |
| title_fullStr | Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries |
| title_full_unstemmed | Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries |
| title_short | Surgical Castration as an Alternative to Improve Systemic Treatment for Advanced Prostate Cancer: A Window of Opportunity for Developing Countries |
| title_sort | surgical castration as an alternative to improve systemic treatment for advanced prostate cancer a window of opportunity for developing countries |
| url | https://ascopubs.org/doi/10.1200/GO-24-00319 |
| work_keys_str_mv | AT fernandosabinomarquesmonteiro surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT andredeekesasse surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT denizarviannaaraujo surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT ranarmckay surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT karinemartinsdatrindade surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT andreysoares surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT joaoricardoalves surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT douglasandreasvalverde surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT diogoassedbastos surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT nicholasdjames surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries AT danielherchenhorn surgicalcastrationasanalternativetoimprovesystemictreatmentforadvancedprostatecancerawindowofopportunityfordevelopingcountries |