Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH, USA.
Appl Health Econ Health Policy. 2011 Sep 1;9(5):305-15. doi: 10.2165/11592200-000000000-00000.
The REDUCE trial examined whether chemoprevention with the dual 5-alpha reductase inhibitor, dutasteride, reduced risk of prostate cancer (PCa) detection on biopsy.
We examined the cost effectiveness of dutasteride compared with placebo in preventing PCa in men at increased risk as seen in REDUCE, from a US payer perspective.
A Markov model was developed to compare costs and outcomes of chemoprevention with dutasteride 0.5 mg/day or placebo with usual care in men aged 50-75 years, with serum prostate-specific antigen (PSA) of 2.5-10 ng/mL (men aged <60 years) or 3.0-10 ng/mL (men aged ≥60 years), and with a single negative prostate biopsy in the prior 6 months. The model simulated the REDUCE cohort annually through different health states over 4-, 10-year and lifetime time horizons. Risks of PCa for men receiving placebo and dutasteride were obtained from REDUCE. Rates of acute urinary retention events and benign prostate hyperplasia-related surgeries also came from REDUCE. Costs and utilities were obtained from published literature. All costs are reported in $US, year 2009 values.
The model indicated that, over 10 years, dutasteride patients would experience fewer PCas (251 vs 312 per 1000 patients) at increased cost ($US15 341 vs $US12 316) than placebo patients. Although life-years were not substantially affected, the model calculated an increase in QALYs of 0.14 for dutasteride patients. Chemoprevention with dutasteride appeared to be cost effective, with an incremental cost per QALY of $US21 781 and cost per PCa avoided of $US50 254. The 4-year and lifetime incremental costs per QALY were $US18 409 and $US22 498, respectively.
Despite increased cost due to taking a drug for prevention, dutasteride 0.5 mg/day may be cost effective in men at increased risk for PCa.
REDUCE 试验研究了双 5α 还原酶抑制剂非那雄胺是否能降低接受活检的前列腺癌（PCa）的风险。
我们从美国支付者的角度，考察了 dutasteride 与安慰剂相比，在 REDUCE 中观察到的高危男性中预防 PCa 的成本效益。
我们开发了一个马尔可夫模型，以比较 dutasteride 0.5mg/天或安慰剂联合常规治疗与单用常规治疗，用于血清前列腺特异性抗原（PSA）为 2.5-10ng/ml（年龄<60 岁的男性）或 3.0-10ng/ml（年龄≥60 岁的男性），且在过去 6 个月内进行过一次阴性前列腺活检的 50-75 岁男性。该模型通过不同的健康状态，每年模拟 REDUCE 队列 4 年、10 年和终生的时间范围。接受安慰剂和 dutasteride 的男性的 PCa 风险来自 REDUCE。急性尿潴留事件和良性前列腺增生相关手术的发生率也来自 REDUCE。成本和效用来自已发表的文献。所有成本均以 2009 年美元计价。
该模型表明，在 10 年内，与安慰剂组相比，dutasteride 组的患者患 PCa 的人数更少（1000 名患者中分别为 251 例和 312 例），但费用更高（15341 美元 vs 12316 美元）。尽管生命年没有明显变化，但模型计算出 dutasteride 组的 QALY 增加了 0.14。用 dutasteride 进行化学预防似乎具有成本效益，每增加一个质量调整生命年的成本为 21781 美元，每避免一例 PCa 的成本为 50254 美元。4 年和终生的增量成本/QALY 分别为 18409 美元和 22498 美元。
尽管由于预防而增加了药物费用，但 dutasteride 0.5mg/天可能在高危 PCa 男性中具有成本效益。
