5α-还原酶抑制剂预防多种患者人群前列腺癌的成本效果分析。
Cost effectiveness of 5-alpha reductase inhibitors for the prevention of prostate cancer in multiple patient populations.
机构信息
RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA.
出版信息
Pharmacoeconomics. 2010;28(6):489-505. doi: 10.2165/11531780-000000000-00000.
BACKGROUND
Although 5-alpha reductase inhibitors (5ARIs) have demonstrated that they reduce the risk of prostate cancer (PCa), they have not demonstrated cost effectiveness in the patient populations in which they have been examined.
OBJECTIVE
A decision-analytic model was created to explore economic benefits from a third-party payer perspective of the use of 5ARIs in preventing PCa in men with different risk factors for developing the disease.
METHODS
A Markov model was developed to simulate a cohort of men annually through health states (e.g. healthy male, benign prostatic hyperplasia [BPH], PCa, PCa recurrence) over a man's lifetime. Men with risk factors were treated with a 5ARI and compared with patients given no chemoprevention. Men from the general population were examined along with higher-risk men who had been referred to a PCa centre. Baseline risk was estimated via published risk data, risk factor analyses and risk equations. Clinical efficacy, morality, costs and utilities were obtained from published literature. Outcomes of the model included number of prostate cancers, incremental costs, incremental QALYs, incremental cost per QALY and number needed to treat. Along with sensitivity and scenario analyses, a validation of outcomes was performed. All costs were valued in $US, year 2009 values. Costs were discounted at 3% per annum.
RESULTS
Men receiving 5ARIs benefited through a reduction in the number of PCas. Assuming a cost-effectiveness threshold of $US50 000 per QALY, chemoprevention with 5ARIs was cost effective ($US37 900 per QALY) in men from the general population who were aged 50 years with elevated prostate-specific antigen (PSA), and who were aged 50 years with PCa family history and elevated PSA ($US31 065 per QALY). Chemoprevention with 5ARIs was not cost effective in men aged 50 years with no additional risk factors, men aged 50 years with abnormal digital rectal examinations (DREs), and men aged 50 years with a family history ($US86 511, $US85 577 and $US84 950 per QALY, respectively). In higher-risk men, chemoprevention could be expected to be cost effective ($US18 490 to $US11 816 per QALY, depending on risk scenario). Results were sensitive to changes in utilities, assumed PCa risk reduction with 5ARIs, and patient age.
CONCLUSION
When considering common risk factors associated with PCa, prevention with 5ARIs is expected to be cost effective in 50-year-old men with elevated PSA. As a man's risk increases, the cost effectiveness of 5ARI chemoprevention improves.
背景
尽管 5-α 还原酶抑制剂（5ARIs）已证明可降低前列腺癌（PCa）的风险，但在接受检查的患者人群中，它们并未显示出成本效益。
目的
从第三方支付者的角度出发，创建一个决策分析模型，探讨使用 5ARIs 预防不同发病风险男性 PCa 的经济效益。
方法
开发了一个马尔可夫模型，以每年模拟一组男性的健康状况（例如健康男性、良性前列腺增生[BPH]、PCa、PCa 复发），直到男性的一生。有风险因素的男性接受 5ARI 治疗，并与未接受化学预防的患者进行比较。普通人群和已转介至 PCa 中心的高风险男性也接受了检查。基线风险通过已发表的风险数据、风险因素分析和风险方程进行估计。临床疗效、死亡率、成本和效用来自已发表的文献。模型的结果包括前列腺癌的数量、增量成本、增量 QALYs、增量成本每 QALY 和需要治疗的人数。除了敏感性和情景分析外，还对结果进行了验证。所有成本均以美元（$US）表示，为 2009 年的价值。成本按每年 3%贴现。
结果
接受 5ARIs 治疗的男性通过减少 PCa 的数量获益。假设每 QALY 50000 美元的成本效益阈值，5ARIs 的化学预防在年龄为 50 岁、前列腺特异性抗原（PSA）升高、年龄为 50 岁且有 PCa 家族史和 PSA 升高的普通人群男性中是具有成本效益的（每 QALY 37900 美元）。在年龄为 50 岁且无其他风险因素、年龄为 50 岁且直肠指检（DRE）异常、以及年龄为 50 岁且有家族史的男性中，5ARIs 的化学预防不具有成本效益（每 QALY 分别为 86511 美元、85577 美元和 84950 美元）。在高风险男性中，化学预防预计具有成本效益（每 QALY 18490 美元至 11816 美元，具体取决于风险情况）。结果对效用的变化、5ARIs 假设的 PCa 风险降低以及患者年龄敏感。
结论
在考虑与 PCa 相关的常见风险因素时，对于年龄为 50 岁且 PSA 升高的男性，5ARIs 的预防预计具有成本效益。随着男性风险的增加，5ARI 化学预防的成本效益会提高。
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