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Monday, 18 October 2004 - 12:15 PM

This presentation is part of: Oral Concurrrent Session A - Public Health 1

ESTIMATING POPULATION EFFECTS FROM PREVENTION TRIALS: AN EXAMPLE USING THE PROSTATE CANCER PREVENTION TRIAL

Steven B. Zeliadt, PhD1, Ruth Etzioni, PhD1, David Penson, MD, MPH2, Ian Thompson, MD3, and Scott Ramsey, MD, PhD1. (1) Fred Hutchinson Cancer Research Center/ University of Washington, Translational and Outcomes Research, Seattle, WA, (2) University of Souther California, Urology and Preventive Medicine, Los Angeles, CA, (3) Health Science Center at San Antonio University of Texas, Surgery, San Antonio, TX

Purpose. This analysis estimates the lifetime cost-effectiveness of using finasteride to prevent prostate cancer based on the 7-year Prostate Cancer Prevention Trial (PCPT). Daily treatment with finasteride in this trial reduced prostate cancer prevalence by 25%; however, an increase in the number of high-grade tumors among the treatment group makes it challenging to translate the trial findings to community practice.

Methods. We use a Markov model to estimate the lifetime impact of finasteride on prostate cancer incidence and death, taking into account benign prostatic hyperplasia (BPH) and associated lifetime medical care costs. We translate the prevalence estimates from the trial into age-conditional probabilities of developing cancer (by grade). We conduct an extensive sensitivity analysis to evaluate the influence of multiple assumptions, including the impact of finasteride on high-grade tumors.

Results. The reduction in low-grade prostate cancer associated with finasteride does not translate into a survival benefit until many years after initiating treatment. Based on the prevalence estimates in the trial, we estimate that finasteride leads to an increase of 5.7 LYs and 46.2 QALYs per 1,000 men treated at an incremental cost of $1,700,000 per LY gained and $200,000 per QALY gained. Assuming finasteride does not increase the incidence of high-grade tumors, the incremental costs are $290,000 per LY gained and $130,000 per QALY gained. We estimate that annual medical care expenditures would increase by $2.2 billion for men age 55 to 64 and $1.2 billion for men age 65 and older, even after accounting for savings from the reduction in prostate cancer and BPH. These estimates assume 50% of eligible men over age 55 in the U.S. would begin daily preventive use of finasteride.

Conclusions. To achieve an incremental cost below $100,000 per QALY gained, finasteride must be shown to prevent high-grade as well as low-grade disease, and the price of the drug must be reduced by at least 50% from its current average wholesale price.


See more of Oral Concurrrent Session A - Public Health 1
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)