{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:05:37Z","timestamp":1788476737816,"version":"build-2803163510"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The combination of second-generation androgen receptor (AR) antagonists with androgen deprivation therapy (ADT) has shown good efficacy and safety in advanced prostate cancer. This study aims to evaluate the cost-effectiveness of three second-generation AR antagonists in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC) in China, providing pharmacoeconomic evidence for clinical drug selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model was constructed based on data from the ARCHES, TITAN, and ARANOTE phase III clinical trials, with a 28-day cycle period. Direct medical costs and quality-adjusted life years (QALYs) were simulated over a 15-year horizon. The incremental cost-effectiveness ratio (ICER) was used as the primary outcome, and a willingness-to-pay (WTP) threshold of three times the 2024 per capita GDP of China was set for cost-utility analysis. Sensitivity analysis was conducted to validate the model\u2019s influencing factors and the robustness of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cumulative cost of the apalutamide regimen was \u00a5776,807, resulting in 4.95 QALYs. Compared to apalutamide, the ICER for enzalutamide was \u00a5643,309\/QALY, while for darolutamide, the ICER was -\u00a540,625\/QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For Chinese mHSPC patients, darolutamide is the most cost-effective treatment at a WTP threshold of \u00a5287,391\/QALY, followed by apalutamide, with enzalutamide being less favorable.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1680002","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T13:18:09Z","timestamp":1760620689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness analysis of second-generation androgen receptor antagonists for the treatment of metastatic hormone-sensitive prostate cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Yang","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Qing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long-Zhuan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.16781\/j.CN31-2187\/R.20240685","article-title":"Prostate cancer in the world and China in 2022: an epidemiological analysis","volume":"46","author":"Qu","year":"2025","journal-title":"Acad J Nav Med Univ"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.16073\/j.cnki.cjcpt.2023.23.09","article-title":"Advancements in health economic evaluation research of drug treatment regimens for prostate cancer","volume":"30","author":"Yang","year":"2023","journal-title":"Chin J Cancer Prev Treat"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"646","DOI":"10.3760\/cma.j.issn.0529-5815.2018.09.002","article-title":"Chinese experts consensus on the treatment of metastatic prostate cancer 2018 edition","volume":"56","year":"2018","journal-title":"Chin J Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1093\/annonc\/mdv245","article-title":"Should docetaxel be standard of care for patients with metastatic hormone-sensitive prostate cancer? 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