The Health Economics of Metastatic Hormone-Sensitive and Non-Metastatic Castration-Resistant Prostate Cancer-A Systematic Literature Review with Application to the Canadian Context

Curr Oncol. 2022 May 7;29(5):3393-3424. doi: 10.3390/curroncol29050275.


Background: Health economic evaluations are needed to assess the impact on the healthcare system of emerging treatment patterns for advanced prostate cancer. The objective of this study is to review the scientific literature identifying cost-effectiveness and cost analyses that are assessing treatments for metastatic hormone-sensitive prostate cancer (mHSPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC). Methods: On 29 June 2021, we searched the scientific (MEDLINE, Embase, and EBSCO) and grey literature for health economic studies targeting mHSPC and nmCRPC. We used the CHEC-extended checklist and the Welte checklist for risk-of-bias assessment and transferability analysis, respectively. Results: We retained 20 cost-effectiveness and 4 cost analyses in the mHSPC setting, and 14 cost-effectiveness and 6 cost analyses in the nmCRPC setting. Docetaxel in combination with androgen deprivation therapy (ADT) was the most cost-effective treatment in the mHSPC setting. Apalutamide, darolutamide, and enzalutamide presented similar results vs. ADT alone and were identified as cost-effective treatments for nmCRPC. An increase in costs as patients transitioned from nmCRPC to mCRPC was noted. Conclusions: We concluded that there is an important unmet need for health economic evaluations in the mHSPC and nmCRPC setting incorporating real-world data to support healthcare decision making.

Keywords: NM-CRPC; clinical trials; cost analysis; cost effectiveness; healthcare-system perspective; mHSPC; prostate cancer; real-world data; review; societal perspective.

Publication types

  • Review
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Androgen Antagonists / therapeutic use
  • Canada
  • Docetaxel / therapeutic use
  • Hormones
  • Humans
  • Male
  • Prostatic Neoplasms, Castration-Resistant* / drug therapy


  • Androgen Antagonists
  • Hormones
  • Docetaxel

Grant support

This study was funded by the Réseau québécois de recherche sur les médicaments (RQRM) via the FRQS (2020). Alice Dragomir is a recipient of the FRQS Chercheur boursier Junior 2 award (FRQS #282257). Ivan Yanev is recipient of the Canadian Association for Healthcare reimbursement scholarship of 2021 and the 100 Days Across Canada scholarship of 2022. Jason R Guertin is a recipient of the FRQS Chercheur boursier Junior 1 award (FRQS #266460).