Cost utility of prostate cancer chemoprevention with dutasteride in men with an elevated prostate specific antigen

Robert S. Svatek, Yair Lotan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, dutasteride reduced the relative risk of prostate cancer (CaP) diagnosis over a 4-year period by 22.8%, but questions remain regarding the cost-effectiveness of widespread utilization. We evaluated the cost utility of chemoprevention using dutasteride in men at elevated risk for CaP. Methods: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate-health-related costs, beginning at age 50, for men treated with dutasteride compared with placebo who are at elevated risk for CaP. Model assumptions were based on data in REDUCE; 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: Under the assumptions of the base case analysis, dutasteride chemoprevention is associated with a gain of 108 quality-adjusted life-years (QALYs) per 1,000 men and the quality-adjusted cost-effectiveness ratio for dutasteride compared with men not receiving chemoprevention was $140,240 per QALYs. At a cost of $626 per year, down from the current cost of $1,400, the model predicts a cost benefit from dutasteride with a willingness-to-pay threshold lower than $50 K. Assuming a 15% period prevalence renders, an incremental cost-effectiveness ratio of $576,630 per QALYs and a 30% period prevalence would yield a $98,059 per QALYs. Conclusions: Dutasteride 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)277-283
Number of pages7
JournalCancer Prevention Research
Volume4
Issue number2
DOIs
StatePublished - Feb 2011

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Chemoprevention
Prostate-Specific Antigen
Prostatic Neoplasms
Costs and Cost Analysis
Quality-Adjusted Life Years
Cost-Benefit Analysis
SEER Program
Dutasteride
Decision Support Techniques
Statistical Models
Health Care Costs
Prostate
Placebos
Quality of Life
Survival
Health

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cost utility of prostate cancer chemoprevention with dutasteride in men with an elevated prostate specific antigen. / Svatek, Robert S.; Lotan, Yair.

In: Cancer Prevention Research, Vol. 4, No. 2, 02.2011, p. 277-283.

Research output: Contribution to journalArticle

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abstract = "Background: In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, dutasteride reduced the relative risk of prostate cancer (CaP) diagnosis over a 4-year period by 22.8{\%}, but questions remain regarding the cost-effectiveness of widespread utilization. We evaluated the cost utility of chemoprevention using dutasteride in men at elevated risk for CaP. Methods: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate-health-related costs, beginning at age 50, for men treated with dutasteride compared with placebo who are at elevated risk for CaP. Model assumptions were based on data in REDUCE; 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: Under the assumptions of the base case analysis, dutasteride chemoprevention is associated with a gain of 108 quality-adjusted life-years (QALYs) per 1,000 men and the quality-adjusted cost-effectiveness ratio for dutasteride compared with men not receiving chemoprevention was $140,240 per QALYs. At a cost of $626 per year, down from the current cost of $1,400, the model predicts a cost benefit from dutasteride with a willingness-to-pay threshold lower than $50 K. Assuming a 15{\%} period prevalence renders, an incremental cost-effectiveness ratio of $576,630 per QALYs and a 30{\%} period prevalence would yield a $98,059 per QALYs. Conclusions: Dutasteride 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.",
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