Cost-effectiveness analysis of rezvilutamide versus bicalutamide and androgen-deprivation therapy in patients with high-volume, metastatic, hormone-sensitive prostate cancer: a Markov’s model-based evaluation

Rezvilutamide, an androgen-receptor inhibitor, has been approved by the Chinese National Medical Products Administration as a first-line treatment for high-volume metastatic hormone-sensitive prostate cancer (mHSPC). This study aims to assess the cost-effectiveness of rezvilutamide plus androgen-deprivation therapy (ADT) compared to bicalutamide plus ADT for the first-line treatment of high-volume mHSPC in China. A Markov model with three health states was developed to evaluate the health and economic outcomes of first-line treatment for high-volume mHSPC. Efficacy data were sourced from the CHART trial. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. To address modeling uncertainties, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. Compared with bicalutamide plus ADT, rezvilutamide plus ADT resulted in an additional 2.16 QALYs, with an ICER of $39,122.16/QALY. At a willingness-to-pay (WTP) threshold of three times the gross domestic product per capita in China for 2023 ($37,256.3/QALY), the probability of cost-effectiveness for rezvilutamide plus ADT was 30%. One-way sensitivity analysis revealed that the results were most sensitive to the cost of rezvilutamide. Scenario analysis indicated that rezvilutamide could be considered cost-effective if priced below $705.46 per cycle. From the perspective of Chinese payers, rezvilutamide plus ADT appears to be a less cost-effective strategy compared to bicalutamide plus ADT for the first-line treatment of high-volume mHSPC in China.