ABSTRACT
The benefits of screening for prostate cancer are uncertain. Outcomes of treatment are particularly important to couples because they challenge the most intimate aspects of a couple's relationship. This study used clinical decision analysis to explore the preferences of 10 couples for prostate cancer screening. The decision-analytic model found that 7 of 10 husbands preferred the no screening strategy, while 9 of 10 wives preferred screening for their husbands. Wives associated little burden with complications of treatment, preferring to maximize their husbands' quantity of life regardless of complications. The issue of who is the decision maker is paramount in the case of prostate cancer screening. Optimal screening strategies may differ for husbands and wives. Guidelines for prostate cancer screening and management should consider assessing preferences on an individual couple basis.
Subject(s)
Decision Making , Mass Screening , Prostatic Neoplasms/prevention & control , Spouses/psychology , Adult , Aged , Decision Support Techniques , Dissent and Disputes , Female , Group Processes , Humans , Male , Middle Aged , Pilot Projects , Prostatic Neoplasms/therapy , Quality-Adjusted Life Years , UncertaintyABSTRACT
BACKGROUND: The issue of whether to screen men for prostate cancer is controversial. No randomized clinical trials have been completed to confirm the efficacy of screening for prostate cancer. We created a mathematical model of the clinical risks and benefits of screening for prostate cancer. METHODS: A Markov decision-analytic model evaluated the outcomes of annually screening asymptomatic men for prostate cancer beginning at age 50 years. The screening and testing algorithm included the digital rectal examination, transrectal ultrasound, and prostate-specific antigen test. A sample of 10 male patients with no history of prostate disease were interviewed to assess their utilities (preferences) regarding the various adverse outcomes of prostate cancer treatment. RESULTS: The model indicated that no screening was preferred to screening when patients' utilities were considered (24.14 vs 23.47 quality-adjusted life years expected). The optimal decision was sensitive to the utilities of impotence and urethral stricture, the most common adverse outcomes for patients under the age of 65 years. When adverse outcomes of treatment were ignored, screening was favored (24.86 vs 24.22 years of life expectancy. CONCLUSIONS: When quality-of-life preferences of men are considered, the annual screening of asymptomatic patients for prostate cancer is not recommended.
Subject(s)
Decision Support Techniques , Mass Screening , Prostatic Neoplasms/prevention & control , Aged , Erectile Dysfunction/etiology , Humans , Male , Markov Chains , Middle Aged , Prostatectomy/adverse effects , Prostatic Neoplasms/therapy , Quality of Life , Radiotherapy/adverse effects , Treatment Outcome , Urethral Stricture/etiologyABSTRACT
A pharmacoeconomic analysis of ondansetron versus metoclopramide use in patients receiving high-dose cisplatin therapy is reported. A meta-analysis of the literature was performed to synthesize the results of clinical trials of ondansetron and metoclopramide for the prevention of nausea and vomiting in patients receiving high-dose cisplatin therapy. A cost-benefit analysis was performed by constructing a decision tree of the possible outcomes of treatment with ondansetron or metoclopramide. Clinical outcomes were measured by counting the emesis episodes occurring within 24 hours after the antiemetic was given and the extrapyramidal reactions occurring after metoclopramide was given. The improvement in quality of life was transformed to an increase in quality-adjusted life years (QALYs) in order to conduct a cost-utility analysis. Only direct costs of drug, materials, and labor were included in the cost calculations. The meta-analysis, combined with empirical observations, yielded expected emesis rates of 2.03 and 2.69 per patient for ondansetron and metoclopramide, respectively. The rate of extrapyramidal symptoms for metoclopramide recipients was 6.8%. The cost-benefit analysis yielded estimated total costs of $139 ($211) and $116 ($154) per 40-kg (70-kg) patient receiving ondansetron and metoclopramide, respectively. The cost-utility analysis yielded an incremental cost of ondansetron of $168,391 ($407,667) per QALY in 40-kg (70-kg) patients. Sensitivity analysis showed robustness of the expected outcomes except in a best-case scenario. A cost-utility analysis suggested that, compared with metoclopramide, ondansetron provides a small antiemetic benefit at a large additional cost.
