Svatek RS et al. (2008) Cost-effectiveness of prostate cancer chemoprevention: a quality of life-years analysis. Cancer 112: 1058–1065

The Prostate Cancer Prevention Trial showed that finasteride chemoprevention reduced the 7-year prevalence of prostate cancer compared with placebo. A previous study, however, showed that widespread use of finasteride chemoprevention would be extremely expensive, with a cost of US$578,400–1,107,000 per life-year saved (well above the generally accepted threshold of US$50,000–100,000 per life-year saved). Svatek and colleagues, the authors of that study, have performed another model-based analysis, this time to examine the cost-effectiveness of finasteride chemoprevention in terms of the quality-of-life improvements associated with the prevention of prostate cancer.

Their Markov decision-analysis model used data from the Prostate Cancer Prevention Trial and the Surveillance, Epidemiology, and End-Results program to compare the lifetime prostate-health-associated costs for men (starting at 50 years of age) who receive finasteride chemoprevention or placebo. The main outcome measure was the cost per quality-adjusted life-year (QALY) saved.

The cost-effectiveness ratio of finasteride chemoprevention, assuming that this treatment reduces overall prostate cancer incidence with an increased incidence of high-grade prostate cancer, was US$122,747 per QALY saved. However, sensitivity analyses showed that, in a high-risk population (prostate cancer prevalence ≥30% in men aged 50 years or older), the cost-effectiveness ratio of chemoprevention was consistently below the upper threshold limit (i.e. <US$100,000 per QALY saved).

The authors conclude that finasteride chemoprevention might be cost-effective in populations at high risk of prostate cancer, so long as quality-of-life adjustments are considered in the calculations.