A within-trial cost-effectiveness analysis of ENZAMET, which randomised 1125 men with metastatic hormone-sensitive prostate cancer. Men received enzalutamide or a conventional non-steroidal antiandrogen alongside testosterone suppression, and were followed 60 months. Costs and quality of life came from trial records, EQ-5D-5L questionnaires and linked Medicare claims. Enzalutamide cost an extra AUD$127,262 per patient, gaining 0.24 life-years and 0.15 QALYs, or AUD$835,580 per QALY. At AUD$50,000 per QALY it had a 6% probability of being cost-effective; AUD$6.73 per tablet would meet the threshold. Primary care costs covered only consenting Australian participants, and costs after progression were not collected.
Why it is interesting: A rare cost-effectiveness analysis using observed trial and claims data rather than a model. Musculoskeletal medicine claims were higher on enzalutamide, though costs were not attributed to falls or fractures.
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