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The cost of prostate cancer chemoprevention: a decision analysis model.

Svatek RS, Lee JJ, Roehrborn CG, Lippman SM, Lotan Y

The University of Texas Southwestern Medical Center at Dallas, TX 75390-9110, USA.

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 dollars 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 dollars per LYS; finasteride must cost 15 dollars monthly to reach 100,000 dollars per LYS. When applied to a population at higher risk (lifetime prevalence of >or=30%) for developing prostate cancer, the cost of finasteride must be reduced from its current cost (62 dollars/mo) to <15 dollars per month for the cost effectiveness to fall below 50,000 dollars 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.

Published 9 August 2006 in Cancer Epidemiol Biomarkers Prev, 15(8): 1485-9.
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