TREATMENT CONSIDERATIONS FOR PERSONS WITH METASTATIC PROSTATE-CANCER - SURVIVAL VERSUS OUT-OF-POCKET COSTS

Objectives. Treatment decisions for metastatic prostate cancer require the consideration of factors such as survival, quality of life, costs of care, and toxicities. In this study, we queried physicians who had extensive experience with prostate cancer about features of metastati c prostate cancer, patients' duality of life, and factors influencing their decision to prescribe flutamide. Methods. Data were gathered thr ough physician surveys and focus group discussions. Demographic inform ation on the physicians and their patients was collected. Physicians m ade assessments of five health states related to metastatic prostate c ancer, based on the time trade-off technique,and on the desirability o f flutamide, based on average expected improvement in survival free of progressive disease, side effects, and drug cost. Results. Physicians were internally consistent in their judgments of the factors most imp ortant to duality of life for individuals with metastatic prostate can cer. Physicians considered bone pain and weight loss/anorexia the most important factors. Physicians who cared for a higher proportion of ol der persons or Medicare recipients rated each scenario as less undesir able than did physicians with a lower proportion of these patients. Ou t-of-pocket cost was the major factor predicting whether a physician w ould prescribe flutamide. Physicians working for health maintenance or ganizations were more likely to prescribe flutamide but were more sens itive to out-of-pocket costs than were other physicians. Conclusions. Physicians varied in their perceptions of quality of life for persons with metastatic prostate cancer and in their willingness to prescribe flutamide. These perceptions and prescribing preferences are strongly influenced by factors other than health status or specific health bene fits. In deciding to prescribe flutamide, concerns over out-of-pocket expenditures loom large for most clinicians. It would be important to know the degree to which these concerns are shared by patients and whe ther prescribing preferences differ for Medicare managed-care patients who have pharmaceutical benefits. Copyright 1997 by Elsevier Science Inc.