Cost-effectiveness and lifetime implications of using finasteride to reduce prostate cancer incidence and mortality

Abstract

1028 Background: Preventive treatment with finasteride has been shown to reduce prostate cancer prevalence by 25% in a large randomized controlled trial. Potential implications include an increased rate of high-grade tumors and higher rates of sexual dysfunction among treated men. This decision analysis evaluates the long-term cost-effectiveness of finasteride. Methods: We estimate the lifetime impact of finasteride on prostate cancer incidence and mortality taking into account benign prostatic hyperplasia, erectile dysfunction, and associated lifetime medical care costs using a Markov process model. Prostate cancer incidence and survival estimates are based on SEER statistics. Incidence rates are adjusted by grade based on the results of the Prostate Cancer Prevention Trial (PCPT). An extensive sensitivity analysis was conducted to evaluate the influence of key assumptions including the impact of finasteride on high-grade tumors. Results: The gains in life-years and quality-adjusted life-years and associated cost-effectiveness estimates are provided in the table below. The incremental cost to gain one QALY fell below $100,000 when the price of finasteride was reduced to $0.86 from the current average wholesale price of $2.71. Conclusions: The cost burden associated with finasteride is substantial, while its survival benefit is small and only realized many years after initiating treatment. Further evidence is needed regarding the impact of finasteride on high-grade prostate cancer. However, our analysis suggests that even if the observed increase in high-grade tumors is a pathologic artifact, adoption of finasteride to prevent prostate cancer is unlikely to be cost-effective. No significant financial relationships to disclose.