Nygård R, Norum J, Due J
Faculty of Medicine, University of Tromsø, N-9037 Tromsø, Norway.
Anticancer Res. 2001 Jan-Feb;21(1B):781-8.
We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives.
65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed.
The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion.
Orchiectomy is the treatment of choice when life expectancy is more than two years.
目前，转移性前列腺癌有两种治疗方案（睾丸切除术或促性腺激素释放激素类似物），二者预期生存率相同。本研究记录了这些方案的生活质量（QoL）和成本效益。
登记了1994年至1999年间在挪威特罗姆瑟大学医院（UHT）接受治疗的65例连续患者。评估时，45例患者（促性腺激素释放激素类似物组——15例患者，睾丸切除术组——30例患者）存活并纳入生活质量研究（欧洲癌症研究与治疗组织核心生活质量问卷C-30、生活质量15D量表）。45例患者在UHT接受随访并纳入成本分析。计算了36个月期间的成本，并换算为英镑（1英镑 = 13挪威克朗）。采用5%的贴现率。
平均生活质量（15D量表）睾丸切除术组为76.4，促性腺激素释放激素类似物组为72（0 - 100分制）。便秘、排尿问题、疲劳、疼痛和性功能丧失是主要症状。每位患者的治疗成本睾丸切除术组为8895英镑，促性腺激素释放激素类似物组为10937英镑。成本交叉点位于25个月。贴现率（0 - 10%）、药物费用（优惠25 - 50%）和治疗时间（12 - 18个月）的敏感性分析未改变结论。
预期寿命超过两年时，睾丸切除术是首选治疗方法。
