Prostate cancer, the PSA test and academic detailing in Australian general practice: an economic evaluation.

OBJECTIVES: To evaluate whether introduction of a national education program for GPs to improve decision making relating to the use of prostate specific antigen (PSA) testing for screening represents 'value-for-money' from the perspective of the Australian Government. METHODS: The annual equivalent costs and consequences of a proposed national program in steady state operation are estimated for Australia using 1996 as the reference year. Because of the controversy about the efficacy of screening using PSA testing, two scenarios are modelled. Uncertainty in the model is examined using Monte Carlo simulation methods. RESULTS: In scenario one, our model predicts that the national program would cost dollars 12.5 million (gross) or dollars 6.6 million (net), would reduce the burden of disease by 4.7% of total DALYs due to prostate cancer in those aged 70 and over, with no loss of life and an incremental cost effectiveness ratio (ICER) of dollars 16,000/DALY (gross) and dollars 8,500/DALY (net). In scenario two, the proposed program would cost dollars 12.5 million (gross) or dollars 7.1 million (net), would reduce the burden of disease by 3.1% of total, increase by 44 the prostate cancer deaths at an ICER of dollars 24,000/DALY (gross) and dollars 14,000/DALY (net). CONCLUSIONS: These findings, with an overall health benefit at moderate cost and acceptable ICER, support the case for consideration of a national education program on the assumption that prostate cancer screening over age 70 does not reduce mortality. A larger Australian study currently being conducted should provide stronger evidence on the value of implementing a full national program.

Rapid increase in statins newly dispensed to Ontario seniors between 1994 and 2000.

BACKGROUND: The Ontario government spent approximately 10% (CDN $148 million) of the provincial medication budget on statins in 1998. This number can be expected to grow in light of new guidelines from the United States recommending that three times as many patients should be receiving antihyperlipidemic therapy. There is scant population-based information on the age and sex distributions of patients receiving these medications. OBJECTIVES: To estimate the rates of new use of statin medications among community-dwelling elderly adults in Ontario between 1994 and 2000. METHODS: Data from the Ontario Drug Benefit program were used on all medications dispensed to noninstitutionalized Ontarians over 65 years of age to estimate age- and sex-specific annual rates of patients newly dispensed a statin. Changes in rates were estimated using Poisson regression. RESULTS: The number of elderly Ontarians newly dispensed a statin increased rapidly between 1994 and 2000, with age-standardized rates rising from approximately 840 to 2600/100,000 women and from 810 to about 3100/100,000 men. The highest rates of new use were observed among patients of both sexes aged 65 to 74 years. However, the rate of change increased with advancing age so that the biggest increase was observed among those aged 85 years and above, among whom there was an 8.5-fold increase among women and a 12-fold increase among men. CONCLUSIONS: Statins have been shown to be safe, efficacious and cost effective in reducing the risk of sudden cardiac death and other acute coronary events among middle-aged patients with pre-existing cardiovascular disease. The present study showed that there was a rapid increase in the rate of statins newly dispensed to elderly patients in Ontario, among whom estimates of safety, efficacy and cost effectiveness are not well quantified. Better estimates of these parameters in the elderly are required because of the high costs and benefits and potential unintended beneficial and harmful effects of statins.