‘Casodex’ (bicalutamide) 150mg a cost effective treatment for the management of locally advanced prostate cancer[1]

New health economic data published in the European Journal of Hospital Pharmacy outline the cost benefits of the non-steroidal anti-androgen bicalutamide 150mg for the treatment of locally advanced prostate cancer. By delaying disease progression in patients with locally advanced prostate cancer, bicalutamide 150mg reduces the additional healthcare costs associated with treating advanced disease.

The paper by Dr Heather Payne, Middlesex Hospital UCL, London states that bicalutamide 150mg impacts less on healthcare budgets compared to other types of cancer treatments.1* An analysis of the cost-effectiveness of bicalutamide 150mg based on the first analysis of the Early Prostate Cancer (EPC) Trial, shows that its estimated cost-effectiveness per quality-adjusted life year (£10,067) falls well below the commonly used threshold for cost-effectiveness (£29,212) and compares well with the cost-utilities of other approaches used in oncology.2,3

The cost of bicalutamide 150mg (administered for three years) plus radical prostatectomy or radiotherapy for locally advanced prostate cancer is also significantly lower compared to the cost of other oncology treatments.2,3

Progression of locally advanced prostate cancer can result in costly complications such as bone metastases and serious skeletal complications.4

In addition, Dr Payne highlights in her paper, that bicalutamide 150mg gives a significant improvement in progression-free survival in patients with locally advanced disease, reducing the risk of objective disease progression by 42% in radiotherapy patients, 47% in watchful waiting patients, and 29% in radical prostatectomy patients.5

As well as being as effective as castration in prolonging survival in non-metastatic prostate cancer6, bicalutamide 150mg has significant quality-of-life benefits, with improvements over castration-based therapies in terms of maintaining bone mineral density, physical capacity and sexual activity.6,7 A recent study of the risk of osteoporosis in men with non-metastatic prostate cancer revealed that those who were treated with bicalutamide 150mg maintained bone mineral density (BMD), whilst those who received castration were associated with a progressive loss of BMD, which can result in costly complications such as increased risk of fractures.7

Dr Payne concludes: “Bicalutamide 150mg is a cost-effective therapy for patients with locally advanced prostate cancer, delaying disease progression, and offers a valuable alternative to castration in this setting”.

Bicalutamide 150mg is indicated in the UK in patients with locally advanced prostate cancer (T3-T4, any N, MO; T1-T2, N+, MO), as immediate therapy either alone or as adjuvant to treatment by radical prostatectomy or radiotherapy. Bicalutamide 150mg is also indicated for the management of patients with locally advanced, non-metastatic prostate cancer for whom surgical castration or other medical intervention is not considered appropriate or acceptable.8

*Data is based on UK NHS costs and may vary in other countries

References:

1. Payne, H. The value of delaying disease progression with bicalutamide (‘Casodex’) 150mg in locally advanced prostate cancer. European Journal of Hospital Pharmacy. 2004.

2. Moeremans K, Caekelbergh K, Annemans L. Cost-effectiveness analysis of bicalutamide (CasodexTM) for adjuvant treatment of early prostate cancer. Value Health 2004; 7: 472-81.

3. Earle CC, Chapman RH, Baker CS, Bell CM, Stone PW, Sandberg EA, Neumann PJ.

Systematic overview of cost-utility assessments in oncology. J Clin Oncol 2000; 18:3302-17.

4. Groot MT, Boeken Kruger CG, Pelger RC, Uyl-de Groot CA. Costs of prostate cancer,

metastatic to the bone, in the Netherlands. Eur Urol 2003; 43: 226-32.

5. Wirth M et al. Bicalutamide (Casodex) 150mg as adjuvant to radical prostatectomy significantly increases progression-free survival in patients with early non-metastatic prostate cancer: analysis at a median follow-up of 5.4 years. J Urol. 2004; 172: 1865–1870.

6. Iversen P, Tyrell CJ, Kaisary AV et al Bicalutamide monotherapy compared with castration in patients with nonmetastatic locally advanced prostate cancer: 6.3 years of followup. J.Urol 2000; 164: 1579-1582.

7. Sieber PR, Keiller DL, Kahnoski RJ et al Bicalutamide 150 mg maintains bone mineral density during monotherapy for localized or locally advanced prostate cancer. Urology 2004; 171: 2272-6.

8. AstraZeneca; Casodex (bicalutamide)150mg Summary of Product Characteristics.