Cost–Effectiveness of Prostate Cancer Chemoprevention among High-risk Men

Authors and Disclosures

Steven B Zeliadt and Scott D Ramsey

¹VA Health Services Research & Development Service, Department of Veterans Affairs Medical Center, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA
²Fred Hutchinson Cancer Research Center, Seattle, WA, USA

^†Author for correspondence
Tel.: +1 206 277 4175 Fax: +1 206 768 534 steven.zeliadt@va.gov

Sidebar

Key Issues

• Chemoprevention with 5-α reductase inhibitors (5ARIs) has been shown in large clinical trials to reduce the risk of prostate cancer (CaP) among low-risk men by 24.8% and among high-risk men with a history of elevated prostate-specific antigen (PSA) and a prior negative biopsy by 22.8%. This reflects primarily a reduction in low-grade disease detected by a study-related biopsy.

• The primary benefit to chemoprevention with 5ARIs is the avoidance of the emotional burden of a diagnosis of cancer, and the adverse effects and costs of treatment; the long-term effect on preventing prostate cancer deaths through 5ARI chemoprevention remains unknown.

• The cost–effectiveness profile is favorable for prescribing 5ARIs to men with multiple risk factors, including a history of elevated PSA and negative biopsy. The current study explored outcomes among very high-risk men, ranging from a 41.5 to 96.6% likelihood of detection of prostate cancer on a subsequent biopsy within 10 years.

• Chemoprevention among average-risk patients is expensive relative to the number of cancers prevented, and does not appear to be a good value for money.

• The costs of 5ARIs are substantial, with finasteride estimated to have a present value cost of US$7900 per treated patient over a 10-year period and dutasteride costing at least 50% more. These costs are prohibitive for widespread population adoption of chemoprevention among men without multiple risk factors for developing prostate cancer.

• Future studies should carefully evaluate the unexpected risk of cardiac failure associated with 5ARIs.