Interventions of Interest:

  • enzalutamide (Xtandi®, Astellas and Medivation)
  • abiraterone acetate (Zytiga®, Janssen)
  • apalutamide (Erleada™, Janssen).

October 2018 Review

ICER developed a report on anti-androgen drugs for high risk prostate cancer.

The added costs of treating earlier stage disease with all therapies are aligned with their added clinical benefits for patients.

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Past Reviews

  • September 2009: Active surveillance and Radical prostatectomy
  • December 2008: Brachytherapy and Proton beam therapy
    Proton beam therapy was also the subject of an evidence review by ICER for the Washington State Health Care Authority in May 2014.
  • November 2007: Intensity modulated radiation therapy (IMRT)

Final Documents

Below you will find the final documents from the assessment review process:

“While data on overall survival improvements are still immature, treating men with high-risk castration-resistant prostate cancer with antiandrogen therapies earlier, before metastatic disease is detected by conventional imaging, appears to improve outcomes. Unfortunately, the lack of long-term survival data and the absence of head-to-head trials limits our ability to compare the effectiveness of enzalutamide with that of the newer drug apalutamide. For abiraterone, we have less certainty in its added benefits when used before cancer progression is detected, making it even more difficult to judge how its effectiveness matches up with the other treatment options. However, for enzalutamide and apalutamide, while there are additional costs associated with earlier treatment, those costs appear to be aligned with the clinical benefits patients receive.”