{
  "abstract": "OBJECTIVETo evaluate the cost-utility and 5-year budget impact of first-line olaparib plus abiraterone versus abiraterone alone for metastatic castration-resistant prostate cancer (mCRPC) in China after the eleventh round of volume-based procurement (VBP). The intention-to-treat (ITT) population was assigned primary decision-analytic weight; the prespecified BRCA1/2-mutated (BRCAm) subgroup was a supporting analysis.\n\nMETHODSA three-state partitioned survival model was built from the Chinese healthcare payer perspective over a 15-year horizon (5% discounting). ITT control-arm survival curves were reconstructed via the Guyot algorithm; the BRCAm control-arm survival curve was median-anchored to the published 23.0-month median. Utilities came from an mCRPC EQ-5D meta-analysis and a Chinese source, valued using the Chinese EQ-5D value set. Post-VBP prices were applied. A Markov model, probabilistic sensitivity analysis, and value-of-information analysis were performed.\n\nRESULTSThe ITT incremental cost-effectiveness ratio (ICER) was CNY 40,198/ QALY (meta-analytic utilities) and CNY 43,721/QALY (Chinese utilities), below the CNY 287,247/QALY willingness-to-pay threshold (3x GDP). The BRCAm ICER was CNY 54,708/QALY and CNY 68,000/QALY, stable across the full OS hazard-ratio confidence interval and conservative survival-cap scenarios. All estimates remained cost-effective under a Markov structure (maximum CNY 120,558/QALY). Probabilistic cost-effectiveness exceeded 99.9%; population expected value of perfect information was zero. The 5-year budget impact was CNY 46.57 million.\n\nCONCLUSIONSAt post-VBP prices, first-line olaparib plus abiraterone is cost-effective, robust across utility sources, survival distributions, and model structures. The BRCAm subgroup shows a hypothesis-consistent signal. These findings support National Reimbursement Drug List inclusion, particularly for the NMPA-approved BRCAm indication, contingent on adequate BRCA testing capacity.\n\nHIGHLIGHTSO_LIThis is the first cost-utility analysis of first-line olaparib plus abiraterone for mCRPC in China at post-volume-based-procurement prices, addressing a gap left by prior pre-VBP Chinese evaluations. C_LIO_LIThe combination is cost-effective across the intention-to-treat and BRCA1/2-mutated populations, robust to utility sources, survival distributions, model structures, and sensitivity analyses, with negligible decision uncertainty at the current willingness-to-pay threshold. C_LIO_LIFindings support National Reimbursement Drug List inclusion, particularly for the NMPA-approved BRCAm indication, contingent on strengthening BRCA testing capacity in tier-2 and tier-3 hospitals. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Soochow University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "name": "J. SHI"
    },
    {
      "name": "Q. Gu"
    },
    {
      "name": "J. Pan"
    },
    {
      "name": "A. Yang"
    },
    {
      "affs": [
        0
      ],
      "name": "M. Fan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/73q146qjyq7v3.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.26.26361314",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361314v1.full",
  "id": "73q146qjyq7v3",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361314v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health economics"
    ],
    [
      "openalex",
      "2002|Health Systems, Economic Evaluations, Quality of Life"
    ]
  ],
  "openalex": "W7204811789",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361314v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/73q146qjyq7v3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:25Z",
      "native_id": "10.64898/2026.08.26.26361314",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.26.26361314v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health economics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Cost-Utility Analysis of First-Line Olaparib plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer in China after Volume-Based Procurement",
  "title_text": "Cost-Utility Analysis of First-Line Olaparib plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer in China after Volume-Based Procurement",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:41Z",
  "url": "https://research.draconitic.com/paper/73q146qjyq7v3",
  "venue": "medRxiv",
  "versions": []
}