Clinical and Cost Impact of Cabazitaxel Versus Lutetium-177 Vipivotide Tetraxetan (Lu-PSMA) for Patients With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Pedro Barata, MD, of University Hospitals Seidman Cancer Center, presents a clinical and economic analysis comparing cabazitaxel and lutetium-177 vipivotide tetraxetan (Lu-PSMA) for patients with metastatic castration-resistant prostate cancer (mCRPC). This cost-consequence model used efficacy and safety data from the randomized Phase 2 TheraP trial to evaluate a cohort of 100 patients from a U.S. Medicare perspective over an 18-month time horizon. While Lu-PSMA demonstrated superior disease control, more patients remained free of progression at 18 months, yet there was no observed overall survival advantage compared to cabazitaxel. Economically, cabazitaxel was associated with substantially lower total costs, representing a savings of approximately $194,000 per patient. This significant difference in expenditure was primarily driven by drug acquisition prices and the requirement for mandatory PSMA testing. These findings highlight a critical clinical-economic trade-off for healthcare resource allocation in mCRPC.