Zeliadt Steven B, Penson David F
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Pharmacoeconomics. 2007;25(4):309-27. doi: 10.2165/00019053-200725040-00004.
The resources devoted to managing metastatic prostate cancer are enormous, yet little attention has been given to directly measuring the economic consequences of treatment alternatives. The purpose of this article was to evaluate the pharmacoeconomics of available treatments for metastatic prostate cancer, including hormone-sensitive disease, androgen-independent prostate cancer and locally advanced/progressive disease. We identified 58 articles addressing economic issues related to metastatic prostate cancer. Treatment alternatives with considerably different costs are available in many areas of disease management, most notably, medical androgen deprivation therapy (ADT) versus surgical castration; combined androgen blockage (CAB) versus monotherapy for initial treatment of hormone-sensitive disease; as well as bisphosphonates and bone-targeted radioisotopes for palliation. The few available pharmacoeconomic studies indicate that the additional costs are not supported by clear and compelling evidence of differences in survival or quality-of-life (QOL) outcomes. Our review revealed that authors often use considerably different assumptions about efficacy and survival outcomes in their analyses, which may be due to the inconsistency of available clinical evidence. Although there have been many clinical trials comparing various therapies, we identified only three trials that included economic assessments. Thus, few sources of economic data are available and most pharmacoeconomic studies rely on information mined from indirect sources. We note that, while there has been considerable enthusiasm about the role of docetaxel regimens in the past 2 years, no study has yet examined the costs of these therapies. Survival remains poor for metastatic disease, thus QOL is the primary consideration for many therapies. However, QOL for treatment of metastatic disease is poorly measured and, in most analyses, the impact of therapy on QOL was inferred based on speculation by the authors. Given the large cost burdens of these treatments, it is essential that we more fully understand the true QOL gains potentially offered by more expensive therapies. The economic studies of advanced prostate cancer highlight several aspects of clinical care that are filled with considerable uncertainty and remain guided by forces other than optimal resource allocation. It is essential that we address the weaknesses in our understanding of the economic consequences of therapies for prostate cancer, and find ways to include economic information into the process of determining optimal therapy.
用于管理转移性前列腺癌的资源极为庞大，但对于直接衡量治疗方案的经济后果却很少有人关注。本文的目的是评估转移性前列腺癌现有治疗方法的药物经济学，包括激素敏感性疾病、雄激素非依赖性前列腺癌以及局部晚期/进展性疾病。我们检索到58篇涉及转移性前列腺癌相关经济问题的文章。在疾病管理的许多领域都有成本差异显著的治疗方案可供选择，最显著的是，药物去势治疗（ADT）与手术去势；联合雄激素阻断（CAB）与激素敏感性疾病初始治疗的单一疗法；以及用于缓解症状的双膦酸盐和骨靶向放射性同位素。现有的少数药物经济学研究表明，额外成本并未得到生存或生活质量（QOL）结果存在差异的确凿证据支持。我们的综述显示，作者在分析中对疗效和生存结果往往采用差异很大的假设，这可能是由于现有临床证据不一致所致。尽管已经有许多比较各种疗法的临床试验，但我们仅发现三项纳入了经济评估的试验。因此，可用的经济数据来源很少，大多数药物经济学研究依赖于从间接来源挖掘的信息。我们注意到，尽管在过去两年中人们对多西他赛方案的作用抱有极大热情，但尚无研究考察这些疗法的成本。转移性疾病的生存率仍然很低，因此生活质量是许多疗法的首要考虑因素。然而，转移性疾病治疗的生活质量评估很差，在大多数分析中，治疗对生活质量的影响是基于作者的推测推断出来的。鉴于这些治疗的巨大成本负担，我们必须更全面地了解更昂贵疗法可能带来的真正生活质量改善。晚期前列腺癌的经济研究凸显了临床护理中几个充满相当不确定性且仍受最优资源分配以外因素指导的方面。我们必须解决在理解前列腺癌治疗经济后果方面的薄弱环节，并找到将经济信息纳入确定最佳治疗方案过程的方法。
