ADVANCED PROSTATE-CANCER - THE ROLE OF HIGH PRICED HORMONE-THERAPY

Objective: To compare the costs of the various options presently avail able in Australia for treatment of advanced prostatic carcinoma by and rogen deprivation. Design: Forty patients underwent a bilateral orchid ectomy for prostatic carcinoma during the 1990/91 financial year at th e Princess Alexandra Hospital, Brisbane. The Yale Cost Model, as adapt ed for use in Australian case-mix projects, was used to derive a diagn osis related group (DRG) cost for this procedure. This was compared wi th the projected cost that would be incurred in treating patients with the various medical alternatives. To enable comparison, expenses were calculated assuming a mean duration of survival of two years. Results : The average cost of a bilateral orchidectomy was $2869. This compare d to $11 253 for goserelin and $12 329 for cyproterone acetate when us ed alone in treat ng a single patient. FlutaMide is presently only app roved for combination therapy with a luteinising hormone-releasing hor mone agonist, and when used with goserelin an average cost of $16 148 per patient was projected. Conclusions: Bilateral orchidectomy is clea rly the cheapest means of hormone manipulation for prostatic carcinoma . Unless the costs of alternative therapies are drastically reduced in Australia, their use is difficult to justify in other than exceptiona l circumstances. We believe their use should be restricted presently t o patients who would otherwise require a bilateral orchidectomy and ha ve an anticipated survival of less than six months.