Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis.
BACKGROUND
We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives.


METHODS
65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed.


RESULTS
The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion.


CONCLUSIONS
Orchiectomy is the treatment of choice when life expectancy is more than two years.
Nygård
R
R
Faculty of Medicine, University of Tromsø, N-9037 Tromsø, Norway.
Norum
J
J
Due
J
J
D000230:Adenocarcinoma / Q000188:drug therapy / Q000191:economics / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D017273:Goserelin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009664:Norway / Q000453:epidemiology; D009919:Orchiectomy / Q000191:economics / Q000523:psychology; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000191:economics / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies
D018931:Antineoplastic Agents, Hormonal; D006727:Hormone Antagonists; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone