A cost-analysis of hormone therapy in advanced prostate carcinoma: Evidence from Treviso, Italy

Objective: In Italy, the standard curative treatment for prostate carcinoma with metastases is the androgen suppression therapy (AST). Recently, intermittent AST has been introduced for the treatment of androgen-responsive patients aged > 75 years in order to reduce the toxicity and cost of treatment, as well as to delay tumor progression. The purpose of this study was to perform a cost-analysis of standard AST, intermittent AST or bilateral surgical castration. Patients and setting: A total of 584 patients from the ULSS 9 (district of Treviso, Veneto, Italy) treated with AST, examined in 1999. Main outcome measures: Parameters adopted in this study were drug prescriptions, length of treatments, biochemical assays and costs of hospital stay. Results: The patients exposed to AST represented 0.33% of the whole male population of the district. Two hundred and sixty-one subjects were aged > 75 years. The largest proportion of the treated population was 78 years-old. Eighty patients had been receiving AST for more than 6 years, and during the year 1999 approximately 50% of them were not prostate-specific antigen (PSA)-tested. Cost-analysis: The yearly treatment cost for prostate cancer per patient was 3,823.46 as assessed in 1999. In order to reduce costs, three scenarios can be considered: a) with the cheapest AST drug (triptorelin, 11.25 mg), the estimated cost would be 3,495.09 patient/year, b) with surgical castration, the estimated cost would be lower (2,268.98 patient/year), and finally c) treatment with intermittent AST of patients > 75 years, previously treated with AST for at least 1 year, would cost 2,525.30 patient/year. Conclusions: In addition to its reduced toxicity, intermittent AST should be extensively considered for use because of the reduced cost of AST therapy, which would be similar to the cost of surgical castration.