Applied Health Economics and Health Policy

, Volume 9, Issue 5, pp 305–315 | Cite as

Cost effectiveness of chemoprevention for prostate cancer with dutasteride in a high-risk population based on results from the REDUCE Clinical trial

  • Michael W. Kattan
  • Stephanie R. Earnshaw
  • Cheryl L. McDade
  • Libby K. Black
  • Gerald L. Andriole
Original Research Article



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 ($US15341 vs $US12316) 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 $US22498, 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.


  1. 1.
    Thompson IM, Goodman PH, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med 2003; 349(3): 213–22CrossRefGoogle Scholar
  2. 2.
    Andriole GL, Bostwick DG, Brawley OW, et al., for the REDUCE Study Group. Effect of dutasteride on the risk of prostate cancer. N Engl J Med 2010; 362: 1192–202PubMedCrossRefGoogle Scholar
  3. 3.
    Earnshaw SR, McDade CL, Black LK, et al. Cost effectiveness of 5-alpha reductase inhibitors for the prevention of prostate cancer in multiple patient populations. Pharmacoeconomics 2010; 28(6): 489–505PubMedCrossRefGoogle Scholar
  4. 4.
    Black L, Naslund MJ, Gilbert TD, et al. An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia. Am J Manag Care 2006; 12: S99–110PubMedGoogle Scholar
  5. 5.
    National Cancer Institute. Surveillance, Epidemiology, and End Results Program. SEER*Stat databases: incidence-SEER 13 Regs public-use, November 2004 sub for expanded races (1992–2002), and incidence-SEER 13 Regs excluding AK public-use, November 2004 sub for Hispanics (1992–2002), released April 2005 [online]. Available from URL: [Accessed 2010 Feb 17]Google Scholar
  6. 6.
    Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol 1993; 150: 85–9PubMedGoogle Scholar
  7. 7.
    Bhatnagar V, Stewart ST, Huynh V, et al. Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment. Prostate Cancer Prostatic Dis 2006; 9: 136–46PubMedCrossRefGoogle Scholar
  8. 8.
    Red book. Vol 52. Greenwood Village (CO): Micromedex, Inc., 2009Google Scholar
  9. 9.
    Coley CM, Barry MJ, Fleming C, et al. Clinical guidelines: early detection of prostate cancer. Part II. Ann Intern Med 1997; 126(6): 468–79PubMedCrossRefGoogle Scholar
  10. 10.
    American Medical Association. Current procedural terminology CPT 2001. Chicago (IL): AMA Press, 2008Google Scholar
  11. 11.
    Ingenix, Inc. The essential RBRVS: a comprehensive listing of RBRVS values for CPT and HCPCS codes. New York: St. Anthony Publishing, 2008Google Scholar
  12. 12.
    Commisson on Cancer. National Cancer Data Base. Benchmark reports (v2.0) [online]. Available from URL: [Accessed 2010 Feb 17]
  13. 13.
    Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 2010; 28(7): 1117–23PubMedCrossRefGoogle Scholar
  14. 14.
    Wolters T, Roobol MJ, Steyerberg EW, et al. The effect of study arm on prostate cancer treatment in the large screening trial ERSPC. Int J Cancer 2010; 126: 2387–93PubMedGoogle Scholar
  15. 15.
    Albertsen PC, Lowe FC, Roehrborn CG. Economic analysis of finasteride: a model-based approach using data from the Proscar long-term efficacy and safety study. Clin Ther 1999; 21(6): 1006–24PubMedCrossRefGoogle Scholar
  16. 16.
    US Department of Labor, US Bureau of Labor Statistics. US city average, not seasonally adjusted medical care [online]. Available from URL: [Accessed 2010 Feb 16]
  17. 17.
    Hanks GE, Dunlap K. A comparison of the cost of various treatment methods for early cancer of the prostate. Int J Radiat Oncol Biol Phys 1986; 12(10): 1879–81PubMedCrossRefGoogle Scholar
  18. 18.
    Litwin MS, Smith RB, Thind A, et al. Cost-efficient radical prostatectomy with a clinical care path. J Urol 1996; 155(3): 989–93PubMedCrossRefGoogle Scholar
  19. 19.
    Burkhardt JH, Litwin MS, Rose CM, et al. Comparing the costs of radiation therapy and radical prostatectomy for the initial treatment of early-stage prostate cancer. J Clin Oncol 2002; 20(12): 2869–75PubMedCrossRefGoogle Scholar
  20. 20.
    Benoit RM, Cohen JK, Miller RJ. Comparison of the hospital costs for radical prostatectomy and cryosurgical ablation of the prostate. Urology 1998; 52(5): 820–4PubMedCrossRefGoogle Scholar
  21. 21.
    Koch MO, Smith Jr JA, Hodge EM, et al. Prospective development of a cost-efficient program for radical retro-pubic prostatectomy. Urology 1994; 44(3): 311–8PubMedCrossRefGoogle Scholar
  22. 22.
    Silverstein AD, Weizer AZ, Dowell JM, et al. Cost comparison of radical retropubic and radical perineal prostatectomy: single institution experience. Urology 2004; 63(4): 746–50PubMedCrossRefGoogle Scholar
  23. 23.
    Penson DF, Schonfeld WH, Flanders SC, et al. Relationship of first-year costs of treating localized prostate cancer to initial choice of therapy and stage at diagnosis: results from the CaPSURE database. Urology 2001; 57: 499–503PubMedCrossRefGoogle Scholar
  24. 24.
    Noe L, Becker R, Williamson T, et al. A pharmacoeconomic model comparing two long-acting treatments for over-active bladder. J Managed Care Pharm 2002; 8(5): 343–52Google Scholar
  25. 25.
    National Vital Statistics. Reports. Deaths: final data for 2005. Table 5: number of deaths and death rates by age, and age-adjusted death rates by specified Hispanic origin, race for non-Hispanic population, and sex: United States, 2005. Natl Vital Stat Rep 2005; 56(10): 23Google Scholar
  26. 26.
    Mittmann N, Trakas K, Risebrough N, et al. Utility scores for chronic conditions in a community dwelling population. Pharmacoeconomics 1999; 15(4): 369–76PubMedCrossRefGoogle Scholar
  27. 27.
    Brenmer KE, Chong C, Tomlinson G. A review and metaanalysis of prostate cancer utilities. Med Decis Making 2007; 27: 288–98CrossRefGoogle Scholar
  28. 28.
    Ackerman SJ, Rein AL, Blute M, et al. Cost effectiveness of microwave thermotherapy in patients with benign prostatic hyperplasia: part I. Methods. Urology 2000; 56: 972–80PubMedCrossRefGoogle Scholar
  29. 29.
    Weinstein MC. From cost-effectiveness ratios to resource allocation: where to draw the line. In: Sloan FA, editor. Valuing health care: costs, benefits, and effectiveness of pharmaceuticals and other medical technologies. New York: Cambridge University Press, 1995Google Scholar
  30. 30.
    Eichler H, Kong SX, Gerth WC, et al. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health 2004; 7: 518–28PubMedCrossRefGoogle Scholar
  31. 31.
    Hirth RA, Chernew ME, Miller E, et al. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000; 20: 332–42PubMedCrossRefGoogle Scholar
  32. 32.
    Hefland BT, Evans RM, McVary KT. Medical treatment of LUTS/BPH: analysis of 8.7 million American men [abstract]. J Urol 2009; 181(4 Suppl.): 647Google Scholar
  33. 33.
    Hershman D, Sundararajan V, Jacobson JS, et al. Outcomes of tamoxifen chemoprevention for breast cancer in very high-risk women: a cost-effectiveness analysis. J Clin Oncol. 2002; 20(1): 9–16PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Michael W. Kattan
    • 1
  • Stephanie R. Earnshaw
    • 2
  • Cheryl L. McDade
    • 2
  • Libby K. Black
    • 3
  • Gerald L. Andriole
    • 4
  1. 1.Cleveland ClinicCleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  2. 2.RTI Health SolutionsResearch Triangle ParkUSA
  3. 3.GlaxoSmithKlineResearch Triangle ParkUSA
  4. 4.Division of UrologyWashington University School of Medicine in St. LouisSt. LouisUSA

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