{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:42:14Z","timestamp":1783489334700,"version":"3.55.0"},"reference-count":54,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chaire pharmaceutique Sanofi sur l\u2019usage optimal des m\u00e9dicaments de l\u2019Universit\u00e9 de Montr\u00e9al","award":["RH000912"],"award-info":[{"award-number":["RH000912"]}]},{"name":"Chaire pharmaceutique Sanofi sur l\u2019usage optimal des m\u00e9dicaments de l\u2019Universit\u00e9 de Montr\u00e9al","award":["337735"],"award-info":[{"award-number":["337735"]}]},{"name":"R\u00e9seau qu\u00e9b\u00e9cois de recherche sur les m\u00e9dicaments (RQRM)\/Fonds de recherche du Qu\u00e9bec (FRQS)","award":["RH000912"],"award-info":[{"award-number":["RH000912"]}]},{"name":"R\u00e9seau qu\u00e9b\u00e9cois de recherche sur les m\u00e9dicaments (RQRM)\/Fonds de recherche du Qu\u00e9bec (FRQS)","award":["337735"],"award-info":[{"award-number":["337735"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>There has been a proliferation of novel treatments for the management of advanced prostate cancer (PCa), including androgen receptor pathway inhibitors (ARPI). Although there are health economic analyses of novel PCa treatments, such as ARPIs for specific health states, there is a lack of sequential analyses. Our paper aims to fill this gap. We developed a Monte Carlo Markov model to simulate the management of advanced PCa to end-of-life. We modeled patients who begin in metastatic and nonmetastatic castration-sensitive PCa (mCSPC and nmCSPC), with risk stratification for mCSPC, progressing to metastatic castration-resistant PCa (mCRPC). Using current guidelines and recent literature, we simulated admissible treatment sequences over these states along a 15-year horizon. We report the best treatment sequences in terms of efficacy and cost-effectiveness. We find that the most cost-effective use of ARPIs is early in advanced PCa for a cost-effectiveness threshold (CET) of CAD 100K per QALY. For a CET of CAD 50K per QALY, early ARPI use is most cost-effective in mCSPC-starting patients but not nmCSPC-starting. We conclude that the most cost-effective way to use ARPIs is when patients first enter advanced PCa. The most cost-effective ARPI at current Canadian prices is abiraterone, mostly due to abiraterone\u2019s lower price level.<\/jats:p>","DOI":"10.3390\/curroncol32040240","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:24:16Z","timestamp":1745180656000},"page":"240","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness Analysis of Contemporary Advanced Prostate Cancer Treatment Sequences"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0025-6714","authenticated-orcid":false,"given":"Valentyn","family":"Litvin","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, University of Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armen G.","family":"Aprikian","sequence":"additional","affiliation":[{"name":"Division of Urology, McGill University, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Dragomir","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, University of Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, L., Lu, B., He, M., Wang, Y., Wang, Z., and Du, L. 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