Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer

Shelby D. Reed, Charles D. Scales, Suzanne Merrill, Jielin Sun, Judd W. Moul, Kevin A. Schulman, Jianfeng Xu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose Improvement in the cost-effectiveness of chemoprevention for prostate cancer could be realized through the identification of patients at higher risk. We estimated the cost-effectiveness of prostate cancer chemoprevention across risk groups defined by family history and number of risk alleles, and the cost-effectiveness of targeting chemoprevention to higher risk groups. Materials and Methods We developed a probabilistic Markov model to estimate costs, survival and quality adjusted survival across risk groups for patients receiving or not receiving chemoprevention with finasteride. The model uses data from national cancer registries, online sources and the medical literature. Results The incremental cost-effectiveness of 25 years of chemoprevention with finasteride in patients 50 years old was an estimated $89,300 per quality adjusted life-year (95% CI $58,800$149, 800), assuming finasteride decreased all grades of prostate cancer by 24.8%. Among patients with a positive family history (without genetic testing) chemoprevention provided 1 additional quality adjusted life-year at a cost of $64,200. Among patients with a negative family history at $400 per person tested, the cost-effectiveness of genetically targeted chemoprevention ranged from $98,100 per quality adjusted life-year when limiting finasteride to individuals with 14 or more risk alleles, to $103,200 per quality adjusted life-year when including those with 8 or more risk alleles. Conclusions Although there are small differences in the cost-effectiveness of genetically targeted chemoprevention strategies in patients with a negative family history, genetic testing could reduce total expenditures if used to target chemoprevention for higher risk groups.

Original languageEnglish (US)
Pages (from-to)841-847
Number of pages7
JournalJournal of Urology
Volume185
Issue number3
DOIs
StatePublished - Mar 1 2011

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Finasteride
Chemoprevention
Genetic Polymorphisms
Cost-Benefit Analysis
Prostatic Neoplasms
Quality-Adjusted Life Years
Alleles
Genetic Testing
Costs and Cost Analysis
Survival
Statistical Models
Health Expenditures
Registries

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Reed, Shelby D. ; Scales, Charles D. ; Merrill, Suzanne ; Sun, Jielin ; Moul, Judd W. ; Schulman, Kevin A. ; Xu, Jianfeng. / Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer. In: Journal of Urology. 2011 ; Vol. 185, No. 3. pp. 841-847.
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Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer. / Reed, Shelby D.; Scales, Charles D.; Merrill, Suzanne; Sun, Jielin; Moul, Judd W.; Schulman, Kevin A.; Xu, Jianfeng.

In: Journal of Urology, Vol. 185, No. 3, 01.03.2011, p. 841-847.

Research output: Contribution to journalArticle

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T1 - Effects of family history and genetic polymorphism on the cost-effectiveness of chemoprevention with finasteride for prostate cancer

AU - Reed, Shelby D.

AU - Scales, Charles D.

AU - Merrill, Suzanne

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AU - Xu, Jianfeng

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N2 - Purpose Improvement in the cost-effectiveness of chemoprevention for prostate cancer could be realized through the identification of patients at higher risk. We estimated the cost-effectiveness of prostate cancer chemoprevention across risk groups defined by family history and number of risk alleles, and the cost-effectiveness of targeting chemoprevention to higher risk groups. Materials and Methods We developed a probabilistic Markov model to estimate costs, survival and quality adjusted survival across risk groups for patients receiving or not receiving chemoprevention with finasteride. The model uses data from national cancer registries, online sources and the medical literature. Results The incremental cost-effectiveness of 25 years of chemoprevention with finasteride in patients 50 years old was an estimated $89,300 per quality adjusted life-year (95% CI $58,800$149, 800), assuming finasteride decreased all grades of prostate cancer by 24.8%. Among patients with a positive family history (without genetic testing) chemoprevention provided 1 additional quality adjusted life-year at a cost of $64,200. Among patients with a negative family history at $400 per person tested, the cost-effectiveness of genetically targeted chemoprevention ranged from $98,100 per quality adjusted life-year when limiting finasteride to individuals with 14 or more risk alleles, to $103,200 per quality adjusted life-year when including those with 8 or more risk alleles. Conclusions Although there are small differences in the cost-effectiveness of genetically targeted chemoprevention strategies in patients with a negative family history, genetic testing could reduce total expenditures if used to target chemoprevention for higher risk groups.

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