Cost-effectiveness of prostate cancer chemoprevention: a quality of life-years analysis.
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.
Svatek
Robert S
RS
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
Lee
J Jack
JJ
Roehrborn
Claus G
CG
Lippman
Scott M
SM
Lotan
Yair
Y
D003362:Cost-Benefit Analysis; D018120:Finasteride / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics* / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015996:Survival Rate
D018120:Finasteride