71 THE COST-EFFECTIVENESS OF THE DOUBLE BENEFIT OF 5-ALPHA-REDUCTASE INHIBITOR (5ARI) CHEMOPREVENTION ON BOTH UNDISCLOSED GENITOURINARY SYMPTOMS AND PROSTATE CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201171 THE COST-EFFECTIVENESS OF THE DOUBLE BENEFIT OF 5-ALPHA-REDUCTASE INHIBITOR (5ARI) CHEMOPREVENTION ON BOTH UNDISCLOSED GENITOURINARY SYMPTOMS AND PROSTATE CANCER Stacy Westerman, Steven Zeliadt, John Gore, and Daniel Lin Stacy WestermanStacy Westerman Seattle, WA More articles by this author , Steven ZeliadtSteven Zeliadt Seattle, WA More articles by this author , John GoreJohn Gore Seattle, WA More articles by this author , and Daniel LinDaniel Lin Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.135AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Use of 5-alpha-reductase inhibitors (5ARI) may have benefit for the prevention of prostate cancer, as well as in the reduction in symptoms of undisclosed genitourinary symptoms never brought to clinical attention. We sought to evaluate the cost effectiveness of chemoprevention with 5ARIs on men over age 50 treated in the Veteran Affairs Healthcare System. METHODS We developed a Markov model with health states for prostate cancer, undisclosed benign prostatic hypertrophy (BPH), and clinically managed BPH beginning at age 50. Age-specific incidence rates of undisclosed and managed BPH were obtained from the literature. The reduction of prostate cancer incidence and BPH-related events on 5ARIs were derived from randomized controlled clinical trials. Men with undisclosed BPH were assigned a utility of 0.93, a 0.04 decline from 0.97 if symptoms were avoided with chemoprevention. We included costs of initial treatment and continuing care for prostate cancer, medical treatment for BPH, clinical BPH events including acute urinary retention and transurethral resection of the prostate, and the annual cost of 5ARI chemoprevention. We conducted sensitivity analyses that varied the cost of 5ARIs from $144/yr based on the Federal supply schedule (FSS) to $521/yr based on the average wholesale price (AWP). RESULTS Without 5ARI chemoprevention, 20.4% of men in our model would be diagnosed with prostate cancer over their lifetime with 3.0% prostate cancer-specific mortality. On 5ARIs, incidence and mortality decreased to 16.5% and 2.5%, respectively. At age 70, our model predicted a 28.5% prevalence of undisclosed BPH without chemoprevention, which would be reduced by half with 5ARI chemoprevention. Our model was sensitive to drug price: the incremental cost-effectiveness ratio ranged from $28,170/quality-adjusted life year (QALY) based on FSS cost, to $88,090/QALY based on AWP. CONCLUSIONS Based on conservative assumptions, 5ARI chemoprevention is cost-effective, particularly in the context of negotiated Federal drug prices. Broader use of chemoprevention with 5ARI could greatly reduce the burden of undisclosed genitourinary symptoms among men in the VA in addition to reducing prostate cancer incidence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e31 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stacy Westerman Seattle, WA More articles by this author Steven Zeliadt Seattle, WA More articles by this author John Gore Seattle, WA More articles by this author Daniel Lin Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...