Dutasteride (Avodart) may only be a cost-effective means of preventing prostate cancer (PCa) in men at very high risk of the disease rather than all men at elevated risk, according to the results of a recent analysis.
Although dutasteride alone and in combination with the alpha blocker tamsulosin (available as Jalyn) is indicated for the treatment of symptomatic benign prostatic hyperplasia, it also is widely prescribed for chemoprevention of PCa.
In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, this 5α-reductase inhibitor decreased the relative risk of prostate cancer by 22.8% over a four-year period. But in a new evaluation of cost utility, dutasteride—at an annual expense of $1,400—has been deemed an impractical method of chemoprevention in men at elevated PCa risk.
Urologists Robert S. Svatek, MD, of The University of Texas (UT) Health Science Center, San Antonio, and Yair Lotan, MD, of UT Southwestern Medical Center, Dallas, used a Markov probability model to determine the lifetime prostate-health-related costs, beginning at age 50, for men at elevated PCa risk who were treated with dutasteride compared with placebo.
In their model, dutasteride chemoprevention led to a gain of 108 quality-adjusted life-years (QALYs) per 1,000 men. Further calculations revealed that the therapy would yield an incremental cost-effectiveness ratio of $98,059 per QALYs at a 30% period prevalence (proportion of the population with a given disease over a specific period of time) or $576,630 per QALYs at a 15% period prevalence.
“The study found that dutasteride was not cost-effective for chemoprevention unless and until a strategy is developed for targeting very-high-risk patients and the cost of the drug decreases,” Dr. Lotan said in a statement summarizing the cost analysis, which was reported in Cancer Prevention Research (2011;4:277-283).
“For the average man, the drug provides minimal survival benefits, and the reduction on treatment-related complications does not compensate for the high costs of every man taking the drug for many years.”