Cost utility of prostate cancer chemoprevention with dutasteride in men with an elevated prostate specific antigen

Background: In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, dutasteride reduced the relative risk of prostate cancer (CaP) diagnosis over a 4-year period by 22.8%, but questions remain regarding the cost-effectiveness of widespread utilization. We evaluated the cost utility of chemoprevention using dutasteride in men at elevated risk for CaP. Methods: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate-health-related costs, beginning at age 50, for men treated with dutasteride compared with placebo who are at elevated risk for CaP. Model assumptions were based on data in REDUCE; 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: Under the assumptions of the base case analysis, dutasteride chemoprevention is associated with a gain of 108 quality-adjusted life-years (QALYs) per 1,000 men and the quality-adjusted cost-effectiveness ratio for dutasteride compared with men not receiving chemoprevention was $140,240 per QALYs. At a cost of $626 per year, down from the current cost of $1,400, the model predicts a cost benefit from dutasteride with a willingness-to-pay threshold lower than $50 K. Assuming a 15% period prevalence renders, an incremental cost-effectiveness ratio of $576,630 per QALYs and a 30% period prevalence would yield a $98,059 per QALYs. Conclusions: Dutasteride 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.