ECONOMIC-EVALUATION OF CHEMOTHERAPY WITH MITOXANTRONE PLUS PREDNISONEFOR SYMPTOMATIC HORMONE-RESISTANT PROSTATE-CANCER - BASED ON A CANADIAN RANDOMIZED TRIAL WITH PALLIATIVE END-POINTS

Purpose: To evaluate the economic consequences of the use of chemother apy in patients with symptomatic hormone-resistant prostate cancer (HR PC) in the context of a previously published Canadian open-label, phas e III, randomized trial with palliative end points. Patients and Metho ds: The trial randomized 161 patients to initial treatment with mitoxa ntrone and prednisone (M + P) or to prednisone alone (P) and showed be tter palliation with M + P,There was no significant difference in surv ival, A detailed retrospective chart review was performed of resources used from randomization until death of 114 of 161 patients enrolled a t the three largest centers: these included hospital admissions, outpa tient visits, investigations, therapies (which included all chemothera py and radiation), and palliative care. Cancer center and community ho spital costs were calculated by using the hotel approximation method a nd case costing from the Ontario Case Cost Project, respectively. Cost -utility analysis was performed by transforming the European Organizat ion for Research and Treatment of Cancer (EORTC) QLQ-C30 global qualit y-of-life item measured every 3 weeks on trial to an estimate of utili ty, and extending the last known value through to death or last follow -up. Results: The mean total cost until death or last follow-up by int ention-to treat was M + P CDN $27,300; P CDN $29,000, The 95% confiden ce intervals on the observed cost difference ranged from a saving of $ 9,200 for M + P (with palliative benefit) to an increased cost of $5,8 00 for M + P. The major proportion of cost (M + P 53% v P 66%; CDN $14 ,500 v $19,100) was for inpatient care. Initial M + P was consistently less expensive in whichever time period war used to compare costs. Co st-utility analysis showed M + P to be the preferred strategy with an upper 95% confidence interval for the incremental cost-utility ratio o f CDN $19,100 per quality adjusted life-year (QALY), Conclusion: A tre atment that reduces symptoms and improves quality of life has the pote ntial to reduce costs in other areas, Economic factors should not infl uence the clinical decision as to whether to use M + P in a symptomati c patient. (C) 1998 by American Society of Clinical Oncology.