Docetaxel with prednisone or prednisolone for the treatment of ...

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Discussion
subsequent chemotherapies and palliative care). As
a result, costs were modelled using aggregate data
and as such the potential impact of the different
treatments on these separate components could
not be reflected in the subsequent analyses. In
addition, resource use and cost data for a number
of the treatment regimens considered were not
available from any source considered. Hence we
assumed that the subsequent follow-up costs for
docetaxel regimens would be similar. In the
absence of comparative data, it is difficult to assess
the robustness of this approach. In addition, UKspecific
cost data for the follow-up costs associated
with treatment with prednisone/prednisolone
alone were not available. Consequently, we
assumed that a similar relationship would hold
between the follow-up costs as was reported for the
comparison of mitoxantrone plus prednisone
versus prednisone/prednisolone alone in the study
by Bloomfield and colleagues. 64 It is unclear how
generalisable the results of this study are to the
NHS setting given the potential for differences in
the subsequent management of patients with
mHRPC between the two settings. However, since
the approach applied was based upon modelling
the relative difference in costs (as opposed to
using the absolute cost estimates) and applying
this to UK-specific follow-up costs, this impact will
be minimised. Furthermore, we quantified the
uncertainty in this relationship using a
probabilistic approach.
Recommendations for research
● Future research should include the assessment
of QoL and utility gain associated with different
treatments including the effect of adverse events
of treatment, using generic instruments, which
are suitable for the purposes of costeffectiveness
analyses.
● Despite detailed consideration of a number of
further research options, there were few easily
identifiable opportunities.