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Cost-Effectiveness Analysis of 177Lu-PSMA-617 Versus Cabazitaxel in Metastatic Castration-Resistant Prostate Cancer from a U.S. Health Care Perspective - Beyond the Abstract

177Lu-PSMA-617 has emerged as a promising radiopharmaceutical therapy for metastatic castration-resistant prostate cancer (mCRPC), offering improved progression-free survival and quality of life compared with cabazitaxel in the TheraP trial. However, its substantially higher cost raises important questions about value within the US healthcare system.

A recent study published in The Journal of Nuclear Medicine evaluated the cost-effectiveness of 177Lu-PSMA-617 versus cabazitaxel using a partitioned survival model informed by real-world data and randomized evidence. By adopting a US healthcare perspective, the analysis reflects country-specific costs, treatment patterns, reimbursement criteria, and resource use that are critical for interpreting economic value.

Key Findings

177Lu-PSMA-617 was associated with a modest improvement in quality-adjusted life-years (QALYs) (0.86 vs 0.76 QALYs) but at a higher total cost, resulting in an incremental cost-effectiveness ratio of $358,990 per QALY. At all willingness-to-pay thresholds in the U.S., the probability of cost-effectiveness remained low.

The main driver of these findings is the combination of limited overall survival benefit and the high cost of 177Lu-PSMA-617. While this radiopharmaceutical therapy improves progression-free survival and patient-reported outcomes, these benefits are not sufficient to offset its current cost. Sensitivity and threshold analyses suggest that cost reductions or greater survival benefit would be required for the therapy to become cost-effective.

Clinical and Economic Implications

From a clinical perspective, 177Lu-PSMA-617 remains an important option. Its favorable toxicity profile and improved quality of life make it particularly relevant for patients who are not ideal candidates for chemotherapy or who prefer to avoid it. As its use expands and moves earlier in the treatment pathway, its clinical and economic value may evolve.

The findings in this study, including base-case analysis, deterministic sensitivity analyses, and probabilistic analyses, provide a comprehensive assessment of the economic burden of 177Lu-PSMA-617 as its clinical use expands in the U.S. and might help inform future reimbursement and policy decisions.

Written by: Kemal C. Gogebakan,1 Natalia Kunst,2 Alireza Ghodsi,3 Lukas Owens,1 Amir Iravani,3,5 Ruth Etzioni4

  1. Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
  2. Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut.
  3. Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, Washington
  4. Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington.
  5. Fred Hutchinson Cancer Center, Seattle, Washington.
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