OBJECTIVES: Prostate cancer (PC) is the most common type of cancer among men in Europe. At diagnosis, metastatic PC is sensitive to androgen deprivation therapy (ADT), and patients are usually referred as having castration-sensitive prostate cancer (mCSPC). The combination of ADT and the androgen pathway inhibitors (ARPI) is the current standard of care for mCSPC. However, PC will develop resistance to ADT and become castration-resistant (mCRPC). This study aimed to review the literature on economic evaluations and health economic models related to mCSPC.

METHODS: A systematic literature search was performed on 8th of September 2023, covering Medline, Embase and Scopus. We also searched in grey literature sources and conducted snowball searches. Studies were eligible if they included patients with mCSPC, contained data on health economic evaluations, had a geographical focus on Europe or North America and were written in English.

RESULTS: The review of 6637 records resulted in the inclusion of 18 peer-reviewed articles, 8 grey literature documents. All studies presented health economic models for the evaluation. The majority of the studies (n=22) had a deterministic Markov structure and applied either Markov cohort or partitioned survival models. In these cases, disease progression or subsequent line of therapy was related to the development of hormone-resistance. In addition, 3 studies applied Markov simulation with specific patient-level events on progression, treatment-related complications or death; and 1 study had hybrid model structure. Most studies investigated various types of ADT based combinations comparing the addition of ARPI, chemotherapy agents or radiation therapy to ADT alone.

CONCLUSIONS: Economic evaluations in the field of prostate cancer are widely published and there are a large number of publications even in the specific sub-group of mCSPC. Regardless of the investigated interventions, most studies apply similar methodologies and simulate patient from mCSPC state until the development of mCRPC or death.