Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer.
OBJECTIVE
Improvement in the cost-effectiveness of chemoprevention for prostate cancer could be realized through the identification of patients at higher risk. We estimated the cost-effectiveness of prostate cancer chemoprevention across risk groups defined by family history and number of risk alleles, and the cost-effectiveness of targeting chemoprevention to higher risk groups.


METHODS
We developed a probabilistic Markov model to estimate costs, survival and quality adjusted survival across risk groups for patients receiving or not receiving chemoprevention with finasteride. The model uses data from national cancer registries, online sources and the medical literature.


RESULTS
The incremental cost-effectiveness of 25 years of chemoprevention with finasteride in patients 50 years old was an estimated $89,300 per quality adjusted life-year (95% CI $58,800-$149,800), assuming finasteride decreased all grades of prostate cancer by 24.8%. Among patients with a positive family history (without genetic testing) chemoprevention provided 1 additional quality adjusted life-year at a cost of $64,200. Among patients with a negative family history at $400 per person tested, the cost-effectiveness of genetically targeted chemoprevention ranged from $98,100 per quality adjusted life-year when limiting finasteride to individuals with 14 or more risk alleles, to $103,200 per quality adjusted life-year when including those with 8 or more risk alleles.


CONCLUSIONS
Although there are small differences in the cost-effectiveness of genetically targeted chemoprevention strategies in patients with a negative family history, genetic testing could reduce total expenditures if used to target chemoprevention for higher risk groups.
Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27715, USA. shelby.reed@duke.edu
Shelby D
SD
Reed
Charles D
CD
Scales
Suzanne B
SB
Stewart
Jielin
J
Sun
Judd W
JW
Moul
Kevin A
KA
Schulman
Jianfeng
J
Xu
D058891:5-alpha Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D000368:Aged; D003362:Cost-Benefit Analysis; D018120:Finasteride / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011471:Prostatic Neoplasms / Q000191:economics* / Q000235:genetics / Q000517:prevention & control*
D058891:5-alpha Reductase Inhibitors; D018120:Finasteride
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