ASCO--In a randomized trial of patients with symptomatic refractory
prostate cancer, chemotherapy plus prednisone provided significantly better
pain control than prednisone alone; now, an economic analysis suggests
that the combination was less expensive overall due to fewer hospital admissions.
Speaking at the ASCO meeting, David J. Bloomfield, MD, of Princess Margaret
Hospital, Toronto, said that the retrospective review of 114 patients showed
a treatment cost, from randomization to death, of $29,000 Canadian with
mitox-antrone (Novantrone) plus prednisone versus $27,300 for prednisone
The dominant cost category was inpatient admissions, accounting for
nearly 60% of total costs. Thus, the cost of the mitoxantrone was more
than offset by an increase in inpatient cost in the predni-sone only arm.
Although there was no difference in survival between the two groups,
a cost utility analysis showed that patients receiving chemotherapy had
more quality-adjusted weeks of life (39.5 versus 27.5 for those on prednisone
Since the confidence interval was plus or minus $6,000, he said, "at
the bottom end of our confidence estimates, the saving could be as much
as $9,200; at the upper end, there is an increased cost of $5,800."
This works out to a cost of $22,400 per quality-adjusted life-year for
mitoxantrone/prednisone, well within the range of other accepted interventions.
Dr. Bloomfield noted that more than half of the patients randomized
to predni-sone alone crossed over to the combination during the trial,
"making the trial one effectively of initial versus delayed mitoxantrone,"
and creating a methodological problem for the cost analysis.
"It is usual to have two equivalent time lines to compare costs,"
he said, "and in this trial there is no right time at which to compare
the two strategies."
To solve this problem, the researchers plotted all resources used in
a time line by date for each patient. A plot of the cumulative mean costs
for all patients showed that mitoxantrone was "consistently cheaper
all along the time line."