Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostate Cancer

For this report, the Technology Evaluation Center, an AHCPR Evidence-based Practice Center of the Blue Cross and Blue Shield Association, conducted a systematic review of the evidence from randomized controlled trials on the relative effectiveness of alternative strategies for androgen suppression as treatment of advanced prostate cancer.

Prostate cancer is a disease of older men, and is second only to lung cancer in cancer mortality for men. For 1998, it was estimated that 184,500 new cases of prostate cancer would be diagnosed, and 39,200 men would die of prostate cancer that year.

In 1994, the total Medicare expenditure for treatment of prostate cancer was $1,411,687,900. Of the total, $477,851,000 was for androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists. The prevalence of prostate cancer, and the expenditures for its treatment, are likely to increase with the aging of the population and the trend to earlier detection of the disease.

Three key issues are addressed in the report:

  • The relative effectiveness of the available methods for monotherapy (orchiectomy, LHRH agonists, and antiandrogens).
  • The effectiveness of combined androgen blockade compared to monotherapy.
  • The effectiveness of immediate compared to deferred androgen suppression.
  • Two supplementary analyses were also conducted for each key question:

  • Meta-analysis of overall survival at 2 or 5 years (as permitted by the data).
  • Cost-effectiveness analysis.
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