Cost-effectiveness of talazoparib plus enzalutamide as first-line therapy in metastatic castration-resistant prostate cancer

Background The TALAPRO-2 trial demonstrated that the combination of talazoparib and enzalutamide significantly improved both progression-free survival (PFS) and overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). However, the cost-effectiveness of this regimen remains unclear due to its high cost. This study aims to evaluate the cost-effectiveness of this combination compared to enzalutamide monotherapy as a first-line treatment for mCRPC. Methods Based on data from the TALAPRO-2 trial, a dynamic Markov model was constructed to simulate disease progression in mCRPC patients. From the perspectives of US and Chinese payers, total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) were considered as the primary outputs in the model. One-way sensitivity analysis and probabilistic sensitivity analysis were used to validate the robustness of the model. Price reduction analysis provides an evidence-based basis for drug pricing and health insurance negotiations by quantifying the impact of price adjustments on economics. Results In the baseline analysis, the ICERs for talazoparib plus enzalutamide were $646,743.72/QALY and $57,635.76/QALY from the U.S. and China perspectives, respectively, which were above the willingness-to-pay thresholds ($150,000 in the U.S. and $40,334 in China). Sensitivity analyses showed that PFS utility values and drug prices impacted the results most. Price adjustment scenarios showed that China needed a 34.5% price reduction to achieve affordability, whereas the U.S. remained unaffordable even with an 80% price reduction. Conclusion At current pricing, talazoparib plus enzalutamide is not cost-effective for mCRPC patients. Optimizing its economic viability may be possible through genetic testing to screen for HRR mutation-positive populations or price negotiations to reduce drug costs. The study supports differentiated pricing strategies to balance clinical benefits with the rational allocation of healthcare resources.