Cost-effectiveness of prostate cancer chemoprevention among high-risk men

EVALUATION OF: Earnshaw SR, McDade CL, Black LK, Bell CF, Kattan MW. Cost effectiveness of 5-α reductase inhibitors for the prevention of prostate cancer in multiple patient populations. Pharmacoeconomics 28(6), 489-505 (2010). Chemoprevention with 5-α reductase inhibitors (5ARIs) has been shown in clinical trials to reduce the incidence of prostate cancer. Although avoiding or delaying a diagnosis of prostate cancer through chemoprevention is attractive, it is unknown whether 5ARI chemoprevention reduces the number of prostate cancer deaths. Prior cost-effectiveness studies have found the adoption of 5ARIs in the general population to not be cost effective owing to the high costs of 5ARIs and multiple years of treatment required before gains are realized. The current study examines the cost-effectiveness of 5ARIs for men with multiple risk factors, including an elevated prostate-specific antigen and a prior negative biopsy. The analysis consistently observes under multiple assumptions that chemoprevention in the subgroup of high-risk men is cost effective and represents a good value for money, while chemoprevention among men from the general population appears to not be cost effective.