Department of Urology, The University of Texas San Antonio, TX, USA.
Cancer Prev Res (Phila). 2011 Feb;4(2):277-83. doi: 10.1158/1940-6207.CAPR-10-0200. Epub 2010 Dec 16.
In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, dutasteride reduced the relative risk of prostate cancer (CaP) diagnosis over a 4-year period by 22.8%, but questions remain regarding the cost-effectiveness of widespread utilization. We evaluated the cost utility of chemoprevention using dutasteride in men at elevated risk for CaP.
A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate-health-related costs, beginning at age 50, for men treated with dutasteride compared with placebo who are at elevated risk for CaP. Model assumptions were based on data in REDUCE; surveillance, epidemiology, and end-results program; literature review of costs, utilities, and transition rates among various prostate cancer health states; and local institutional cost data.
Under the assumptions of the base case analysis, dutasteride chemoprevention is associated with a gain of 108 quality-adjusted life-years (QALYs) per 1,000 men and the quality-adjusted cost-effectiveness ratio for dutasteride compared with men not receiving chemoprevention was $140,240 per QALYs. At a cost of $626 per year, down from the current cost of $1,400, the model predicts a cost benefit from dutasteride with a willingness-to-pay threshold lower than $50 K. Assuming a 15% period prevalence renders, an incremental cost-effectiveness ratio of $576,630 per QALYs and a 30% period prevalence would yield a $98,059 per QALYs.
Dutasteride is unlikely to be cost effective when considering the impact on survival differences among treated versus untreated groups. However, chemoprevention may be cost effective in high-risk populations when taking into consideration adjustments for the impact on quality of life.
在多沙唑嗪减少前列腺癌事件研究（REDUCE）试验中，度他雄胺在 4 年内将前列腺癌（CaP）的诊断相对风险降低了 22.8%，但关于广泛应用的成本效益仍存在疑问。我们评估了度他雄胺在患有 CaP 风险升高的男性中的化学预防的成本效益。
设计了一个马尔可夫决策分析模型，结合概率敏感性分析，以确定从 50 岁开始，接受度他雄胺治疗的男性与接受安慰剂治疗的男性相比，患有 CaP 风险升高的男性的终生前列腺健康相关成本。模型假设基于 REDUCE 中的数据；监测、流行病学和结果计划；文献综述了各种前列腺癌健康状况的成本、效用和转换率；以及当地机构的成本数据。
在基本情况分析的假设下，度他雄胺化学预防与每 1000 名男性增加 108 个质量调整生命年（QALY）相关，与未接受化学预防的男性相比，度他雄胺的质量调整成本效益比为每 QALY 140,240 美元。在每年 626 美元的成本下，低于目前的 1400 美元，模型预测度他雄胺的成本效益具有低于 50K 的意愿支付阈值。假设 15%的期间患病率为基础，增量成本效益比为每 QALY 576,630 美元，30%的期间患病率将产生每 QALY 98,059 美元。
考虑到治疗组与未治疗组之间的生存差异的影响，度他雄胺不太可能具有成本效益。然而，当考虑到对生活质量的影响的调整时，化学预防在高危人群中可能具有成本效益。
