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Orchiectomy—surgical removal of the testicles to suppress testosterone, which can promote the growth of prostate cancer cells—is more cost effective than suppressing the hormone through other means, according to a recent study supported by the Agency for Healthcare Research and Quality (290-97-0015).
Using a computer model, researchers predicted that a man with recurrent prostate cancer who undergoes orchiectomy would incur costs of about $7,000 overall and live an average of 5.1 quality-adjusted life years. Quality-adjusted life years are the years of life saved by a technology or service, adjusted to reflect the quality of those years. All other currently used treatments, including nonsteroidal antiandrogens, luteinizing hormone-releasing agonist (LHRH) drugs, and combined androgen blockade—an LHRH agonist drug combined with a nonsteroidal antiandrogen medication or surgery—cost more and extend survival by a shorter time.
For men who prefer to avoid surgery, diethylstilbestrol (DES) was used as a baseline in the study. At one time, DES was a widely used treatment, but it is now rarely employed because of increased cardiac deaths associated with the drug.
The researchers, who were led by Ahmed M. Bayoumi, M.D., of the University of Toronto, also examined how cost-effectiveness varies with the time of initiation of therapy, whether prompted by symptoms or biochemical evidence of disease progression using prostate specific antigen monitoring. The study was based on an evidence report on testosterone suppression treatment for prostatic cancer, which was produced by the Blue Cross-Blue Shield Evidence-based Practice Center under contract to AHRQ.
Details are in "Cost-effectiveness of androgen suppression therapies in advanced prostate cancer," by Dr. Bayoumi, Adalsteinn Brown, A.B., and Alan M. Garber, M.D., in the November 2000 Journal of the National Cancer Institute 92, pp. 1731-1739.
Editor's Note: Copies of Evidence Report/Technology Assessment No. 4, Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer (AHRQ Publication No. 99-E012) and the summary of the report (AHRQ Publication No. 99-E011) are available from the AHRQ Publications Clearinghouse.
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