Cost‐effectiveness of prostate cancer chemoprevention

Svatek, Robert S.; Lee, John; Roehrborn, Claus G.; Lippman, Scott M.; Lotan, Yair

doi:10.1002/cncr.23276

Cited by 58 publications

(37 citation statements)

References 90 publications

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“…This study and previous analyses of the PCPT found a modest survival advantage in the chemoprevention arms of the studies (4,5,16). The survival advantage of 108 QALYs per 1,000 men conferred by dutasteride is small but not surprising.…”

Section: Discussionsupporting

confidence: 60%

“…Studies such as the PCPT and REDUCE did not evaluate these outcomes so they need to be extrapolated from the data using cost-utility modeling. We previously created a markov model based on the results of PCPT to predict the costeffectiveness and quality-adjusted cost-effectiveness of chemoprevention using finasteride to prevent prostate cancer (4,5). The REDUCE trial utilized dutasteride in men with higher risk for prostate cancer as compared with the PCPT.…”

Section: Introductionmentioning

confidence: 99%

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Cost Utility of Prostate Cancer Chemoprevention with Dutasteride in Men with an Elevated Prostate Specific Antigen

Svatek¹,

Lotan²

2011

Cancer Prevention Research

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Background: 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.Methods: 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.Results: 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 costeffectiveness 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.Conclusions: 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. Cancer

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Cost Utility of Prostate Cancer Chemoprevention with Dutasteride in Men with an Elevated Prostate Specific Antigen

Svatek¹,

Lotan²

2011

Cancer Prevention Research

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“…Utility is used in decision analyses for groups of patients or individuals, [15][16][17] in cost-effectiveness studies, [18][19][20] as a measure of population health 21 or as an outcome measure in clinical trials. 22,23 It is a single number, conventionally scaled between "1" (full health) and "0" (dead) that represents that desirability of a health outcome, relative to these scale anchors.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Among men with normal sexual function preoperatively, 2.1% (at 0 to 3 months), 7.4% (at 3 to 9 months), 18.1% (at 9 to 18 months) and 30.1% (at 18 to 30 months) were able to maintain full erections or erections sufficient for intercourse, but with some reduction in firmness (Table 2).…”

Section: Impact Of Rp On Hrqol Among Patients With Normal Function Atmentioning

confidence: 99%

Changes in health utilities and health-related quality of life over 12 months following radical prostatectomy

Krahn

Trachtenberg

et al. 2013

CUAJ

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Introduction: Although radical prostatectomy (RP) is an effective treatment for prostate cancer, it has potentially deleterious effects on health-related quality of life (HRQoL). Utility is an important global measure of HRQoL. This utility is also used in decisionmaking models and economic evaluations. There are no published prospective data characterizing men's utilities for health outcomes post-RP. Methods: From July 2003 to June 2006, patients undergoing RP atthe University Health Network in Toronto, Ontario, Canada, completed the Patient-Oriented Prostate Utility Scale (PORPUS), a disease-specific HRQoL and utility instrument. Men were included if they had clinically localized prostate cancer and had completed HRQoL measures prior to surgery and at least once within 9 to 18 months after the RP. Health-related quality of life was measured prior to surgery and at 4 stages after surgery: 0 to 3 months, 3 to 9 months, 9 to 18 months, and 18 to 30 months. Statistical analyses included pairwise t-tests and multivariable linear regression comparing changes in scores between baseline and the 9-to 18-month range.Results: Two hundred and thirteen men (mean age 60.9, median Gleason score 7) met the inclusion criteria. At baseline, HRQoL was high (mean PORPUS-P [psychometric] = 83.8). Scores declined sharply by 3 months (65.5, p < 0.001) and improved but did not reach baseline by 9-18 months (75.1, p < 0.001). Utility scores (PORPUS-U[utility]) showed the same pattern: 0.94 at baseline; 0.81 at 3 months (p < 0.001); and 0.88 at 9 to 18 months (p < 0.001). Predictors of HRQoL, including baseline PORPUS score, nerve-sparing surgery and smoking status, decline after RP. Conclusion:Symptom scores are known to be affected up to 12 months after RP. Our study demonstrates that global health status also declines and remains affected 1 year after surgery.Can Urol Assoc J 2009;3(6):445-52 RésuméIntroduction : La prostatectomie radicale est un traitement efficace contre le cancer de la prostate, mais elle présente des effets indési -rables potentiels ayant un impact sur la qualité de vie liée à la santé (QdVS), dont l'état de santé est une importante mesure globale. Cette mesure est aussi utilisée dans les modèles décisionnels et les évaluations économiques. Aucune donnée prospective n'a été publiée concernant l'état de santé des patients après une PR. Méthodologie : Entre juillet 2003 et juin 2006, des patients ayantsubi une PR au sein du University Health Network à Toronto (Ontario) au Canada ont rempli le questionnaire PORPUS d'auto-évaluation, un instrument de mesure de la qualité de vie reliée à la santé et de l'état de santé. Étaient inclus les hommes atteints d'un cancer de la prostate cliniquement localisé et ayant été évalués à l'aide d'instruments de mesure de la QdVS avant l'intervention chirurgicale et au moins une fois dans les 9 à 18 mois suivant la PR. La qualité de vie reliée à la santé a été mesurée avant la chirurgie et à 4 reprises par la suite : après 0 à 3 mois, 3 à 9 mois, 9 à 18 mois et 18 à 30 mois...

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“…Worldwide, it is the second most common non-cutaneous cancer in men, accounting for 10% of male cancers. In recent years, 5-year survival rates for PCa have been ranked third highest of all cancers (Desireddi et al 2007, Svatek et al 2008. Although chemotherapy historically has had limited utility in treating advanced PCa, the results from two recent randomized clinical trials indicated that docetaxel (DTX)-based chemotherapy improved survival in patients with hormone-refractory prostate cancer (HRPC; Patel et al 2005, Armstrong et al 2007.…”

Section: Introductionmentioning

confidence: 99%

The TORC1/TORC2 inhibitor, Palomid 529, reduces tumor growth and sensitizes to docetaxel and cisplatin in aggressive and hormone-refractory prostate cancer cells

Gravina

Marampon²,

Petini³

et al. 2011

Endocrine-Related Cancer

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One of the major obstacles in the treatment of hormone-refractory prostate cancer (HRPC) is the development of chemo-resistant tumors. The aim of this study is to evaluate the role of Palomid 529 (P529), a novel TORC1/TORC2 inhibitor, in association with docetaxel (DTX) and cisplatin (CP). This work utilizes a wide panel of prostatic cancer cell lines with or without basal activation of Akt as well as two in vivo models of aggressive HRPC. The blockade of Akt/mTOR activity was associated to reduced cell proliferation and induction of apoptosis. Comparison of IC50 values calculated for PTEN-positive and PTEN-negative cell lines as well as the PTEN transfection in PC3 cells or PTEN silencing in DU145 cells revealed that absence of PTEN was indicative for a better activity of the drug. In addition, P529 synergized with DTX and CP. The strongest synergism was achieved when prostate cancer (PCa) cells were sequentially exposed to CP or DTX followed by treatment with P529. Treatment with P529 before the exposure to chemotherapeutic drugs resulted in a moderate synergism, whereas intermediated values of combination index were found when drugs were administered simultaneously. In vivo treatment of a combination of P529 with DTX or CP increased the percentage of complete responses and reduced the number of mice with tumor progression. Our results provide a rationale for combinatorial treatment using conventional chemotherapy and a Akt/mTOR inhibitor as promising therapeutic approach for the treatment of HRPC, a disease largely resistant to conventional therapies.

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Cost‐effectiveness of prostate cancer chemoprevention

Cited by 58 publications

References 90 publications

Cost Utility of Prostate Cancer Chemoprevention with Dutasteride in Men with an Elevated Prostate Specific Antigen

Cost Utility of Prostate Cancer Chemoprevention with Dutasteride in Men with an Elevated Prostate Specific Antigen

Changes in health utilities and health-related quality of life over 12 months following radical prostatectomy

The TORC1/TORC2 inhibitor, Palomid 529, reduces tumor growth and sensitizes to docetaxel and cisplatin in aggressive and hormone-refractory prostate cancer cells

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