Cost-effectiveness of prostate cancer chemoprevention: A quality of life-years analysis

Robert S. Svatek, J. Jack Lee, Claus Roehrborn, Scott M. Lippman, Yair Lotan

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

BACKGROUND. The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride reduces the prevalence of prostate cancer by 24.8% (risk reduction) but questions remain regarding the cost-effectiveness of widespread utilization. The purpose of the current analysis was to evaluate the cost-effectiveness of chemoprevention utilizing a quality-of-life adjustment. METHODS. A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate health-related costs, beginning at age 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the PCPT; Surveillance, Epidemiology, and End-Results program; literature review of costs, utilities, and transition rates among various prostate cancer health states; and local institutional cost data. RESULTS. The quality-adjusted cost-effectiveness ratio for finasteride compared with men not receiving chemoprevention was $122,747 (in U.S.$) per quality-adjusted life-years saved (QALYs). If finasteride is assumed to not increase the incidence of high-grade tumors, the quality-adjusted cost-effectiveness ratio was $112,062 per QALYs. Sensitivity analysis found that chemoprevention of prostate cancer with an agent that has no effect on the prevalence of benign prostatic hyperplasia can render a cost-effectiveness ratio of <$50,000 per QALYs saved when applied to a high-risk population associated with a 25% risk reduction, and a cost of $30 per month. CONCLUSIONS. Finasteride is unlikely to be cost-effective when considering the impact on survival differences among treated versus untreated groups. However, chemoprevention may be cost-effective in high-risk populations when taking into consideration adjustments for the impact on quality of life.

Original languageEnglish (US)
Pages (from-to)1058-1065
Number of pages8
JournalCancer
Volume112
Issue number5
DOIs
StatePublished - Mar 1 2008

Keywords

  • Chemoprevention
  • Decision analysis model
  • Prostate cancer
  • Quality of life

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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