Increased use of 6-monthly gonadotropin-releasing hormone agonist therapy for prostate cancer: a capacity and cost-minimization analysis for England

Cornford, Philip ORCID: 0000-0002-7146-9258, Halpin, Caolan, Sassmann, Jelena, Frankcom, Ian and Braybrook, Saran (2023) Increased use of 6-monthly gonadotropin-releasing hormone agonist therapy for prostate cancer: a capacity and cost-minimization analysis for England. JOURNAL OF MEDICAL ECONOMICS, 26 (1). pp. 208-218.

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Official URL: http://dx.doi.org/10.1080/13696998.2023.2172281

Abstract

<h4>Aims</h4>The National Health Service (NHS) in England is facing extreme capacity pressures. The backbone of prostate cancer care is gonadotropin-releasing hormone agonist (GnRHa) therapy, commonly administered every month or 3 months. We estimated the cost and capacity savings associated with increased use of 6-monthly GnRHa therapy in England.<h4>Methods</h4>A capacity and cost-minimization model including a societal perspective was developed (in Microsoft Excel) to generate cost and capacity estimates for GnRHa drug acquisition and administration for "Current practice" and for a "Base case" scenario. In the "Base case" scenario, 50% of patients who were receiving monthly or 3-monthly GnRHa therapy in "Current practice" switched/transitioned to a 6-monthly formulation. Cost/capacity estimates were calculated per patient per administration and scaled to annualized population levels. Sensitivity analyses were conducted to assess the impact of individual model assumptions: 1 tested the impact of drug acquisition costs; 2 and 3 tested the level of nurse grade and the time associated with treatment administration, respectively; 4 tested the rate of switch/transition to 6-monthly GnRHa therapy; and 5 tested differing diagnostic patterns following the coronavirus disease 2019 pandemic.<h4>Results</h4>Compared with "Current practice", the "Base case" scenario was associated with annual cost savings of £5,164,296 (148,478 fewer appointments/year and 37,119 fewer appointment-hours/year). The largest savings were in drug administration (£2.2 million) and acquisition (£1.6 million) costs. Annual societal cost savings totaled £1.4 million, mainly in reduced appointment-related travel, productivity and leisure time opportunity losses. Increased use of 6-monthly versus monthly or 3-monthly GnRHa therapy consistently achieved system-wide annual cost and capacity savings across all sensitivity analysis scenarios.<h4>Conclusions</h4>Our holistic model suggests that switching/transitioning men from monthly or 3- monthly GnRHa therapy to a 6-monthly formulation can reduce NHS cost and capacity pressures and the societal and environmental costs associated with prostate cancer care.

Item Type:	Article
Uncontrolled Keywords:	Budget impact, capacity, cost, cost-minimization, England, efficiency, gonadotropin-releasing hormone agonist (GnRHa), National Health Service (NHS), prostate cancer, resource
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine
Depositing User:	Symplectic Admin
Date Deposited:	18 May 2023 13:39
Last Modified:	18 May 2023 13:40
DOI:	10.1080/13696998.2023.2172281
Open Access URL:	https://doi.org/10.1080/13696998.2023.2172281
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3170501