The cost of prostate cancer chemoprevention: A decision analysis model

Background: The Prostate Cancer Prevention Trial found reduced prostate cancer prevalence for men treated with finasteride. The public health cost of wide-scale chemoprevention is unclear. We developed a model to help clarify the cost effectiveness of public use of prostate cancer-preventive agents. Methods: A Markov decision analysis model was designed to determine the lifetime prostate health-related costs, beginning at the age of 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the Prostate Cancer Prevention Trial, a literature review of survival and progression rates for patients treated with radical prostatectomy, and costs associated with prostate cancer disease states. Results: Chemoprevention with finasteride resulted in a gain of 13.7 life years per 1,000 men at a cost of $704,000 per life year saved (LYS). However, if finasteride is assumed to not increase the incidence of high-grade tumors, it renders a gain of 21.4 life years per 1,000 men at a cost of $434,000 per LYS; finasteride must cost $15 monthly to reach $100,000 per LYS. When applied to a population at higher risk (lifetime prevalence of >30%) for developing prostate cancer, the cost of finasteride must be reduced from its current cost ($62/mo) to <$15 per month for the cost effectiveness to fall below $50,000 per LYS. Conclusions: Given the natural history of treated prostate cancer, implementation of chemoprevention would require an inexpensive medication with substantial cancer risk reduction to be cost effective. Targeting populations at higher risk for developing prostate cancer, however, allows for considerable flexibility in the medication cost to make prostate cancer chemoprevention a more attainable goal.