Treatment considerations for persons with metastatic prostate cancer: survival versus out-of-pocket costs.
OBJECTIVE
Treatment decisions for metastatic prostate cancer require the consideration of factors such as survival, quality of life, costs of care, and toxicities. In this study, we queried physicians who had extensive experience with prostate cancer about features of metastatic prostate cancer, patients' quality of life, and factors influencing their decision to prescribe flutamide.


METHODS
Data were gathered through physician surveys and focus group discussions. Demographic information on the physicians and their patients was collected. Physicians made assessments of five health states related to metastatic prostate cancer, based on the time trade-off technique, and on the desirability of flutamide, based on average expected improvement in survival free of progressive disease, side effects, and drug cost.


RESULTS
Physicians were internally consistent in their judgments of the factors most important to quality of life for individuals with metastatic prostate cancer. Physicians considered bone pain and weight loss/anorexia the most important factors. Physicians who cared for a higher proportion of older persons or Medicare recipients rated each scenario as less undesirable than did physicians with a lower proportion of these patients. Out-of-pocket cost was the major factor predicting whether a physician would prescribe flutamide. Physicians working for health maintenance organizations were more likely to prescribe flutamide but were more sensitive to out-of-pocket costs than were other physicians.


CONCLUSIONS
Physicians-varied in their perceptions of quality of life for persons with metastatic prostate cancer and in their willingness to prescribe flutamide. These perceptions and prescribing preferences are strongly influenced by factors other than health status or specific health benefits. In deciding to prescribe flutamide, concerns over out-of-pocket expenditures loom large for most clinicians. It would be important to know the degree to which these concerns are shared by patients and whether prescribing preferences differ for Medicare managed-care patients who have pharmaceutical benefits.
Matchar
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DB
Center for Health Policy Research and Education, Duke University, Durham, NC 27708-0253, USA.
McCrory
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DC
Bennett
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CL
D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D005485:Flutamide / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
D018931:Antineoplastic Agents, Hormonal; D005485:Flutamide