Goserelin (Zoladex (R)) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis

Background: We have today two treatment alter-natives (orchiectomy or LHRH- analogue) in metastatic prostate cancer offering the same expectations of s urvival. This study documents the quality of life (QoL) and cost-effectiven ess of these alternatives. Patients and Methods: 65 consecutive patients tr eated at the University Hospital of Tromso (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue - 15 patien ts, orchiectomy - 30 patients) were alive and included in the QoL-study (EO RTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and include d in the cost-analysis. Costs were calculated for a 36-month interval and c onverted to British pounds (1 pound = 13 NOK). A 5% dr was employed. Result s: The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-200 scale). C onstipation, urinating problems, fatigue pain and loss of sexual functionin g were the dominant symptoms. The treatment costs per patient treated were pound8,895 (orchiectomy) and pound 10,937 (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rat e (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion. Conclusion: Orchiectomy is the treatment of choic e when life expectancy is more than two years.