Cost-effective models for flutamide for prostate carcinoma patients: are they helpful to policy makers?
BACKGROUND
More than 50,000 male patients received hormonal therapy for metastatic prostate carcinoma in 1995. Nonsteroidal antiandrogens, such as flutamide, when used in conjunction with castration, are effective in prolonging the time to progression of disease and survival. Only one-third of newly diagnosed patients with metastatic prostate carcinoma receive flutamide. Physicians may be reluctant to prescribe flutamide because of quality of life, toxicity, and cost considerations.


METHODS
Physician focus groups evaluated quality of life factors for metastatic prostate cancer.


RESULTS
Using quality of life estimates with the National Cancer Institute's (NCI) 0036 clinical trial results, our revised model of flutamide use predicted that, for minimal disease, survival increased by 4.33 quality adjusted months (QAMs) at an incremental cost of $25,000 per quality adjusted life year (QALY) saved and for severe disease, survival increased by 4.11 QAM at a cost of $18,000 per QALY saved. However, if quality of life estimates are used in conjunction with the Prostate Cancer Trialists' Collaborative Group (PCTCG) meta-analysis estimates, survival increased by 2.1 QAM at an incremental cost of $41,000 per QALY saved for persons with severe disease and increased by 2.6 QAM at an incremental cost of $53,700 per QALY saved for persons with minimal disease.


CONCLUSIONS
Using NCI 0036 trial data, flutamide has an incremental cost-effectiveness more favorable than most therapies, while estimates based on the PCTCG found a less favorable outcome for the drug. Concerns about out-of-pocket expenditures and efficacy limit flutamide utilization; quality of life considerations are less cogent.
Bennett
C L
CL
Lakeside Veterans Administration Medical Center, Chicago, Illinois 60601, USA.
Matchar
D
D
McCrory
D
D
McLeod
D G
DG
Crawford
E D
ED
Hillner
B E
BE
D000726:Androgen Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000556:secondary; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005485:Flutamide / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017144:Focus Groups; D017048:Health Care Costs; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D015337:Multicenter Studies as Topic; D009316:National Institutes of Health (U.S.); D009919:Orchiectomy; D011050:Policy Making; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D026712:Value of Life
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D005485:Flutamide