Cost-effectiveness of prostate cancer chemoprevention: A quality of life-years analysis

Robert Svatek, J. Jack Lee, Claus G. Roehrborn, Scott M. Lippman, Yair Lotan

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1058-1065
Number of pages8
JournalCancer
Volume112
Issue number5
DOIs
StatePublished - Mar 1 2008
Externally publishedYes

Fingerprint

Finasteride
Chemoprevention
Cost-Benefit Analysis
Prostatic Neoplasms
Quality of Life
Quality-Adjusted Life Years
Costs and Cost Analysis
Risk Reduction Behavior
SEER Program
Social Adjustment
Decision Support Techniques
Prostatic Hyperplasia
Statistical Models
Health Care Costs
Population
Prostate
Placebos
Survival
Incidence
Health

Keywords

  • Chemoprevention
  • Decision analysis model
  • Prostate cancer
  • Quality of life

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cost-effectiveness of prostate cancer chemoprevention : A quality of life-years analysis. / Svatek, Robert; Lee, J. Jack; Roehrborn, Claus G.; Lippman, Scott M.; Lotan, Yair.

In: Cancer, Vol. 112, No. 5, 01.03.2008, p. 1058-1065.

Research output: Contribution to journalArticle

Svatek, R, Lee, JJ, Roehrborn, CG, Lippman, SM & Lotan, Y 2008, 'Cost-effectiveness of prostate cancer chemoprevention: A quality of life-years analysis', Cancer, vol. 112, no. 5, pp. 1058-1065. https://doi.org/10.1002/cncr.23276
Svatek, Robert ; Lee, J. Jack ; Roehrborn, Claus G. ; Lippman, Scott M. ; Lotan, Yair. / Cost-effectiveness of prostate cancer chemoprevention : A quality of life-years analysis. In: Cancer. 2008 ; Vol. 112, No. 5. pp. 1058-1065.
@article{4b5e66f732384ed2ae3f40da5371dc95,
title = "Cost-effectiveness of prostate cancer chemoprevention: A quality of life-years analysis",
abstract = "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.",
keywords = "Chemoprevention, Decision analysis model, Prostate cancer, Quality of life",
author = "Robert Svatek and Lee, {J. Jack} and Roehrborn, {Claus G.} and Lippman, {Scott M.} and Yair Lotan",
year = "2008",
month = "3",
day = "1",
doi = "10.1002/cncr.23276",
language = "English (US)",
volume = "112",
pages = "1058--1065",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "5",

}

TY - JOUR

T1 - Cost-effectiveness of prostate cancer chemoprevention

T2 - A quality of life-years analysis

AU - Svatek, Robert

AU - Lee, J. Jack

AU - Roehrborn, Claus G.

AU - Lippman, Scott M.

AU - Lotan, Yair

PY - 2008/3/1

Y1 - 2008/3/1

N2 - 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.

AB - 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.

KW - Chemoprevention

KW - Decision analysis model

KW - Prostate cancer

KW - Quality of life

UR - http://www.scopus.com/inward/record.url?scp=39749113833&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39749113833&partnerID=8YFLogxK

U2 - 10.1002/cncr.23276

DO - 10.1002/cncr.23276

M3 - Article

C2 - 18186497

AN - SCOPUS:39749113833

VL - 112

SP - 1058

EP - 1065

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 5

ER -