Considerazioni cliniche ed economiche nel trattamento del cancro della prostata: analisi costo-efficacia di bicalutamide vs flutamide in combinazione con LHRH

Abstract

Prostate carcinoma (PC) is the most common malign neoplasm found in men over 65 years of age. In Italy, the incidence of this cancer is around 60/100,000/year, corresponding to about 11,000 new cases each year. Patients with PC consume health resources for a cost that is 10-24% higher than that of similar populations without PC. It is estimated that in Italy, each year, there are 19,000 hospitalizations for prostate cancer in patients over 65, a figure that represents 4% of the total hospitalizations for oncological diseases. We conducted a marginal cost/effectiveness analysis of bicalutamide vs. flutamide, both administered in combination with LHRH, in patients with advanced (metastatic) PC, on the basis of a randomized trial comparing 4 strategies of total androgenic blockade (TAB). The analysis was conducted in the perspective of the SSN (National health system). The comparison revealed that drug acquisition costs are not the only determinants of the economical differences between the two therapeutical strategies. Furthermore, we demonstrated that prolonged survival of the patients does not increase the consumption of health resources, since the chronological shift of the terminal phase reduces the value of the resources dedicated to it. When conducing the cost/effectiveness analysis, the survival advantage associated to bicalutamide has been adjusted to balance the low quality of life of PC patients. The pharmacoeconomical benefit of bicalutamide resulted of 12,150 Euro/QALY, while the cost per year of life saved resulted inferior, ranging from 8.327 to 11.440 Euro. This cost/QALY value is nevertheless lower than that associated to several therapeutical strategies that are commonly accepted in developed countries (domiciliar hemodialysis, heart transplantation, breast cancer screening, etc.). Considering that 12.150 Euro/QALY is the highest estimate of the relative cost/effectiveness of bicalutamide, it appears that the combination bicalutamide + LHRH represents an economically acceptable alternative to flutamide + LHRH in advanced PC patients.