OBJECTIVES: The REDUCE trial examined whether chemoprevention with a 5-alpha reductase inhibitor, dutasteride, reduced the rate of prostate cancer (PCa) detection on biopsy. We examine the cost-effectiveness of using dutasteride compared with usual care in preventing PCa in men at increased risk as seen in REDUCE.
METHODS: A Markov model was developed to compare the costs and outcomes of chemoprevention with dutasteride 0.5 mg/day or usual care in men 50–75 years, with serum prostatespecific antigen (PSA) of 2.5–10 ng/mL (<60 years) or 3.0–10 ng/mL (>= 60 years), and a single negative, prostate biopsy in prior 6 months. The model simulated the REDUCE cohort of men annually through different health states (e.g. healthy male, PCa, BPH, PCa recurrence) over ten years. Risk of PCa for usual care and dutasteride patients was obtained from REDUCE, where dutasteride showed a reduced risk of 23% and no significant increase in high grade tumors. Additional benefits in terms of reduction in benign prostate hyperplasia (BPH) progression (e.g. surgeries, acute urinary retention) were considered. Impact of adverse events (e.g., incontinence, erectile dysfunction, ejaculatory dysfunction) were considered. Costs and utilities were obtained from the published literature.
RESULTS: Dutasteride patients experienced fewer PCa’s (334 vs. 410 per 1000 patients) and increased costs ($17,237 vs. $13,800) compared with usual care patients. Although life years were not significantly impacted, dutasteride patients incurred an increase in quality-adjusted life years (QALYs) of 0.15. Chemoprevention with dutasteride was found to be cost-effective with an incremental cost per QALY of $22,562. Results were robust to changes in parameters.
CONCLUSIONS: Despite increased costs, due to taking a daily drug for prevention, the use of dutasteride is cost-effective in men at increased risk for PCa. Use of dutasteride for PCa prevention in the appropriate population could reduce the cost associated with the treatment of PCa and prevent reductions in quality of life associated with PCa treatment.
