 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / January 2005Casodex (bicalutamide) 150mg, cost effective treatment for the managem
Casodex (bicalutamide) 150mg, cost effective treatment for the management of locally advanced prostate cancer 18 Jan 2005 New data published in the European Journal of Hospital Pharmacy - New health economic data published today 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 -ends- *Data is based on UK NHS costs and may vary in other countries NOTES TO EDITORS: -- Exchange rate: 1 British Pound (GBP) = 1.42633 Euro (EUR) -- The bicalutamide ('Casodex') Early Prostate Cancer (EPC) programme is evaluating bicalutamide 150mg/day plus standard care (watchful waiting, radical prostatectomy or radiotherapy) in patients with localised or locally advanced prostate cancer. -- The EPC programme is the largest prostate cancer treatment study to date including over 8,000 patients from 23 countries around the world. -- Bicalutamide 150mg belongs to a group of medicines called anti-androgens. This means that it interferes with some of the actions of androgens (male sex hormones) within the body. For further information, please contact: Rosie Allen Hill & Knowlton Tel: (UK) 020 7413 3141 Mob: (UK) 07913 172597 Tara Breen Hill & Knowlton Tel: (UK) 020 7413 3760 Mob: (UK) 07813 252 673 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. knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > Casodex (bicalutamide) 150mg, cost effective treatment for the > management of locally advanced prostate cancer Has anyone in the group had treatment with Casodex by itself, not in combination with Lupron or Zoladex? If so, can you comment on the side effects? Thanks, Alan Since the health warning issued on Casodex 150 late in 2003, I think many Casodex users have migrated down to the 50 mg dosage...Best wishes and good health, Ron But that's the ADT2/3 dosage, which I think even the manufacturer's trials showed to be ineffective as monotherapy. Why waste money and SEs on 50mg monotherapy? (Or am I wrong? I'm only 80% sure of the last half of my opening sentence.) I.P. > Since the health warning issued on Casodex 150 late in 2003, I think > many Casodex users have migrated down to the 50 mg dosage> But that's the ADT2/3 dosage, which I think even the manufacturer's trials showed to be ineffective as monotherapy. Why waste money and SEs on 50mg monotherapy? (Or am I wrong? I'm only 80% sure of the last half of my opening sentence.) I.P. ================= i'm going out of a limb, because it's been years since i research casodex. it was quite common in the arsenal of drugs against pca at one time. if i remember correctly, what makes casodex so effective against the growth of pca was the drug's ability to "plug" the receptor of the pca cell so that it couldn't reproduce and if it can't reproduce, then, at least you have something you can work with against the cancer. and like all drugs, there are positives and negatives to each side. i don't remember that much on the negative side because the ones who were using the drug never complained about it. i could see where casodex would be a cheaper treatment than others in how the drug works. by dropping from 150 mg to 50mg, i guess my question would be - can you maintain the same level of resistance to pca reproduction at a 50mg level or are you giving up QOL for the reduced dosage. now, i haven't seen anything that address that issue. just my 02 cents.......... ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc "Alan Meyer" <ameyer2@yahoo.com> wrote > > Has anyone in the group had treatment with Casodex by itself, > not in combination with Lupron or Zoladex? > > If so, can you comment on the side effects? And if anyone who has tried Casodex monotherapy lives in the U.S., how did you obtain it and at what price? It's not approved in the U.S., so we'd have to a) buy it from a foreign source (thus pay for it ourselves and risk paying $7,200 a year for a fake or worse) or b) get it as part of a self-administered ADT2 or 3 protocol and just not take the other parts of the protocol (until our insuror or physician caught us at it and lowered the boom). OTOH, if anyone can show clinical proof that Casodex monotherapy does any good, I may be willing to run those gauntlets. Its primary, almost sole, SE is supposed to be diarrhea, and I'd risk that for a trial period given proof it helps significantly. So far I've not found that proof. I.P. > "Alan Meyer" <ameyer2@yahoo.com> wrote > >> Has anyone in the group had treatment with Casodex by itself, [quoted text clipped - 14 lines] > > I.P. I remember someone posting to this group, he might have been English, Canadian, or Australian, saying that he was on an intermittent HT treatment plan that alternated casodex and one of the LHRH agonists (Lupron or Zoladex, don't remember which). It would be impossible to say whether his cancer was being held at bay more effectively by this treatment than other hormone therapies but, IIRC, he did report that the Casodex alone portion of the treatment did lower his PSA pretty effectively. Alan > > Casodex (bicalutamide) 150mg, cost effective treatment for the > > management of locally advanced prostate cancer [quoted text clipped - 7 lines] > > Alan Original DX in 02 after PSA 13 and Gleasons of 6,7,7,and 9 at age 69. Cryo in January 03 - PSA dropped below 1, but began to rise. Biopsy DX indicated small Gleason 6, and repeat cryo done in January 04. PSA down to .54, but increased over 1. RX for casodex (50 mg) and proscar (5 mg) in June 04. PSA down to .04 in August and stable in October. Off casodex until Dec. when PSA .15. Resumed casodex 01/05. Next PSA due in March 05. Anticipated continuation of casodex until 07. Urologist indicates no aggresive ADT indicated until current treatment no longer effective. Side effects minimal - primarily tenderness and some swelling of breasts, and some fatigue. No SE usually associated with lupron. Rack rate for casodex and proscar in U.S. about $500.00 per month (Casodex is around $380-$420, and available at any major drug chain, but don't know about 150 mg). Currently being purchased in Mexico for half that price. Canadian prices slightly higher than Mexico, but product available in Mexico is produced by Astra-Zeneca and in sealed packaging. Celebrex (200 mg) being taken with casodex and proscar. Urologist indicated OK to stop celebrex, but probably OK to continue since no cardiovascular problems. Also taking vitamin E, selenium, pomegranate juice, and lycopene. Diet otherwise normal. So far, so good. But, as the Indians say, "Only the rocks live forever." Jack in Phoenix Hi, Jack! Glad to see you back, but sorry to hear 2004 has been a problem for you. I'm sure you were always wary of that 9 Gleason. I think I am becoming a proponent of IHT or IADT, but if that was the intent of your doc, I gotta feeling he began a little too early. I don't know what the right time to start is, but I suspect it's at least a year after initial HT treatment.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > > > Casodex (bicalutamide) 150mg, cost effective treatment for the > > > management of locally advanced prostate cancer [quoted text clipped - 37 lines] > > Jack in Phoenix My understanding is that the usual plan with casodex and proscar is to stop treatment after PSA is down and stable and to restart when it rises. Some urologists prescribe it on a schedule of nine months on and three months off. I guess this is more proof that, "No two doctors agree on PCa treatment." The schedule was discussed with the uro in October when I was given the alternative to go with the nine month schedule. I elected to take a couple of months off, so I can't blame the MD if it was too soon. Incidentally, I have tried to find out the half life of casodex, but can't come up with any answers. Jack in Phoenix > Hi, Jack! Glad to see you back, but sorry to hear 2004 has been a problem > for you. I'm sure you were always wary of that 9 Gleason. I think I am [quoted text clipped - 57 lines] > > > > Jack in Phoenix I suspect IP will have an answer for you on that one. > Incidentally, I have tried to find out the half life of casodex, but > can't come up with any answers. > > Jack in Phoenix No, but Google did: I entered Casodex bicalutamide half life, and it spat out http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPro/Bicalutamide.htm . More than we'd ever want to know about the pharmacokinetics of Casodex. The short answer: one week. The long answer includes a huge array of data, come of it even interesting, including a big chart on its SEs. I.P. > I suspect IP will have an answer for you on that one. > > > Incidentally, I have tried to find out the half life of casodex, but > > can't come up with any answers. I have a longer post on here today, but will reply to this too. I took Casodex for about a month and the urologist wanted to add Lupron. That one caused real sexual problems for me before and I think Casodex did too, but maybe it is all in my head. Because of my concerns with the sexual side effects, I got a second opinion from my oncologist. He took me off the Casodex and said to come back in a couple of months after a new PSA. The reason I was on the drug was due to my PSA going up over 3 years, after my radical prostectomy, to 2.0 from 0 and a Gleason score of 8 with some other concerns about possible spread beyond the prostate. Fortunately for me the PSA stopped going up even w/o the Casodex and I am taking nothing now. The oncologist says not to worry, that he has guys walking around with 800 PSA scores. He said that he does not treat the numbers. He did order a full CAT scan and Bone Scan and nothing showed up. Casodex is available in the USA. Mine was paid for by my health plan, but I know the price is high. Those economic studies don't impress me as I figure my life is worth more than a million dollars or whatever. Heck we will pay hundreds of thousands to fix up a criminal who gets shot up by the police after trying to kill them or someone else. Our medical costs are not so simple as some people like to think. I also want to be able to sue any doctor who messes me up or messes up a member of my family. I do try to pick a good doctor, just to avoid that. Those doctors, like good drivers, need to be rewarded with low cost insurance, even it is provided by the government. They also need insurance companies or the government that is not afraid to fight lawsuits when the doctor is innocent of wrong doing. Now that is getting off the subject. Sorry. Bye, George You took Casodex alone, as in monotherapy, in the U.S.? That's good to hear. I knew they were tying to get FDA approval for that, but could find no record of its approval. I was set to pay for it myself if I had to and it will help me without intolerable SEs. <ALottoWin@yahoo.com> wrote > > Casodex is available in the USA. Mine was paid for by my health plan, > but I know the price is high. Now THERE is a topic for discussion! How much is a life worth? Or the temporary extension of life? Whether it be national health care to which you contributed less than $100,000 in taxes in the last 30 years or insurance to which you personally and/or your employer paid premiums of less that $100,000 in 30 years. How much should be spent on YOU (pl)? or ME? No, wait? National health care is even more interesting. How much should be spent on the criminal who contributed almost nothing and, often, took more than he contributed. Or the on the billionaire who contributed millions of dollars in taxes? Or the lotto winner who contributed $100,000 until he hit the state's mother lode and was taxed before dispersement of the winnings? I'm thinking I may have already used up my $100,000. What is my value beyond that? I lived 50 years. I sired three children, each of whom are upstanding members of the community and are each producing offspring. I've contributed to my community beyond anyone's expectations. But, I have little else to contribute. In five years, maybe two, or maybe tomorrow, I will sit on my laurels and reap the supposed reward of my work -- pension checks and tax-deferred savings. Though this may sound like depression, this is a philosophical question. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I have a longer post on here today, but will reply to this too. I took > Casodex for about a month and the urologist wanted to add Lupron. That [quoted text clipped - 26 lines] > > Bye, George > Now THERE is a topic for discussion! How much is a life worth? Or the > temporary extension of life? [quoted text clipped - 21 lines] > > Though this may sound like depression, this is a philosophical question. Steve. You ask an interesting question, but perhaps you should first try to get an accurate idea of the accounting. I don't myself know the answers, but I already see some problems with your arithmetic. First, of all, I'm pretty sure my employer plus myself contributed more than $100,000 during the last 30 years towards health insurance. In addition, because health costs have been escalating rapidly, there has to be some correction for inflation. There are other serious issues of this kind to take into account. This is best left to experts, but unfortunately even experts may differ. In any case, faulty arithmetic can bias your philosophical answer. Getting back to the basic question, let me give my slant on the thing. There are two extremes here. Either everyone pays his own way, or we group together to share risk. In reality, we always have some combination of the two. If we all pay our own way, then some of us who are unlucky because we incur large medical expenses probably won't receive adequate care. A single serious illness can wipe out even the most prudent middle class family's resources. Sharing risk is handled by insurance schemes where everyone contributes roughly the same premium, but the benefits are returned unequally according to need. Then some people get more than their "fair share" and others get relatively little returned. They do get some peace of mind, of course. Insurance schemes work best if the pool is large and not restricted. Insurance companies are in business to make money, so they prefer to divide the pool up into categories which help them minimize their risk, but don't particularly help those being insured. Also, smaller insurance companies can fail, and in reality they do, leaving the insured out in the cold no matter how much they have contributed. So the best insurance schemes are those which are very wide spread and in which the insurer is as safe and financially sound as possible. Under the present system, in the US we are managing to pay for the medical care we receive, more or less. So their must be some rough balance between input and output. Some people without medical insurance or with inadequate insurance don't get very good care, but they usually get some. Of course, there also has to be some way to control the costs, and whether you like it or not, that has to involve some scheme for price controls on the providers. There is already such a system for Medicare which, believe it or not, was instituted under the Reagan administration, the most consevative in recent history except for the current Bush administration. If the government doesn't do it, then private insurers will do it, as they do today under managed care, but less effectively and more unequally. Part of the control of prices involves when and if society will pay for unusual or experimental treatments. This will be partly based on science and partly based on politics. For example, because of an alliance between a very conservative Republican and a moderate Democrat, dietary and herbal supplements are subject to less control today than prescription medicines. Public pressure also intrudes when private insurers are involved, but it is not as effective. With all that in mind, I would say the following about your case. I think your contribution to society is not really relevant. In the case of health care, it is your need that should determine how much care you should receive, subject of course to the limits of what is likely to be effective. In this, in extreme cases, cost might be a factor. If I end up being lucky and my cancer never recurs, I don't object to more being spent on taking care of your prostate cancer than will be spent on mine. I hope that I will remain relatively healthy for the rest of my life and die relatively quickly and inexpensively. If offered the opportunity to extend my life for a few weeks or months by an astonomically expensive treatment, my inclination would be to refuse it, even if I don't have to pay for it. So if I never use what I've contributed towards paying for health, it doesn't bother me one bit. It might go the other way, and the peace of mind is worth it. > With all that in mind, I would say the following about your case. I > think your contribution to society is not really relevant. In the case > of health care, it is your need that should determine how much care you > should receive, subject of course to the limits of what is likely to be > effective. Interesting. To each man in accordance with his needs. I believe I read that somewhere. You are correct, of course, that $100,000 is no longer the 30-year average for healthcare insurance or tax burden. I do believe that if you think about how much you paid 30 years ago, that in the last 30 it was $100,000 or less. But, in reality, $100,000 is a nice round figure. You are also correct that for prostate problems, I will surpass $100,000 sooner than you. With a 4-day hospital stay for Diverticulitis, a 4-day hospital stay for a jellyfish sting, an 8-day RPP, 35 EBRTs and several Lupron shots, I suspect I already passed it. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum On the positive (?) side, many others died without getting any of their $100,000. Part or their $100k is now yours, guilt-free. I.P. > Now THERE is a topic for discussion! How much is a life worth? Or the > temporary extension of life? [quoted text clipped - 21 lines] > > Though this may sound like depression, this is a philosophical question. >Subject: Re: Casodex (bicalutamide) 150mg, cost effective treatment for >themanagem >From: ALottoWin@yahoo.com >Date: 1/23/2005 11:22 PM Central Standard Time >Message-id: <1106544141.046814.114690@z14g2000cwz.googlegroups.com> Two years. 2.0 It is growing somewhere, probably not in the prostate bed. Doc is right, as long as you are not experiencing symptoms you can wait, and some men don't have symptoms 'til 800 or 1000. Hormones will bring that right back down to near zero, for a while. My doc is aggresive- I've never been above 153 but I'm in my second program of chemotherapy. All symptoms so far are directly attributable to the treatments ;-} >I have a longer post on here today, but will reply to this too. I took >Casodex for about a month and the urologist wanted to add Lupron. That [quoted text clipped - 26 lines] > >Bye, George >Subject: Re: Casodex (bicalutamide) 150mg, cost effective treatment for >themanagem >From: "Steve Kramer" skramer@cinci.rr.com >Date: 1/22/2005 6:43 AM Central Standard Time >Message-id: <ATrId.48162$re1.10400@fe2.columbus.rr.com> Casodex and Proscar cut my PSA from 12 to 0.5 in just over two months, in 2001, just after RRP. I took it for about two years. Sore breasts for a while. >Hi, Jack! Glad to see you back, but sorry to hear 2004 has been a problem >for you. I'm sure you were always wary of that 9 Gleason. I think I am [quoted text clipped - 44 lines] >> >> Jack in Phoenix |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.