COST-EFFECTIVE MODELS FOR FLUTAMIDE FOR PROSTATE CARCINOMA PATIENTS -ARE THEY HELPFUL TO POLICY-MAKERS

BACKGROUND, More than 50,000 male patients received hormonal therapy f or metastatic prostate carcinoma in 1995. Nonsteroidal antiandrogens, such as flutamide, when used in conjunction with castration, are effec tive in prolonging the time to progression of disease and survival. On ly one-third of newly diagnosed patients with metastatic prostate carc inoma receive flutamide. Physicians may be reluctant to prescribe flut amide because of quality of life, toxicity, and cost considerations. M ETHODS, Physician focus groups evaluated quality of life factors for m etastatic prostate cancer. RESULTS, Using quality of life estimates wi th the National Cancer Institute's (NCI) 0036 clinical trial results, our revised model of flutamide use predicted that, for minimal disease , survival increased by 4.33 quality adjusted months (QAMs) at an incr emental cost of $25,000 per quality adjusted life year (QALY) saved an d for severe disease, survival increased by 4.11 QAM at a cost of $18, 000 per QALY saved. However, if quality of life estimates are used in conjunction with the Prostate Cancer Trialists' Collaborative Group (P CTCG) meta-analysis estimates, survival increased by 2.1 QAM at an inc remental cost of $41,000 per QALY saved for persons with severe diseas e and increased by 2.6 QAM at an incremental cost of $53,700 per QALY saved for persons with minimal disease. CONCLUSIONS, Using NCI 0036 tr ial data, flutamide has an incremental cost-effectiveness more favorab le than most therapies, while estimates based on the PCTCG found a les s favorable outcome for the drug. Concerns about out-of-pocket expendi tures and efficacy limit flutamide utilization; quality of life consid erations are less cogent.