Role of Perspective and Other Uncertainties in Cost-Effectiveness Assessments in Advanced Prostate Cancer
Abstract
EDITORIALS Bruce E. Hillner, John D. Roberts Both its natural history and typical age at presentation make prostate cancer a disease for whose treatment the largest thirdparty payer is the U.S. taxpayer. Medicare payments for prostate cancer treatment were estimated to be $1.4 billion in 1994 (1). Therefore, the cost-effectiveness analysis by Bayoumi et al. (2) in this issue of the Journal, addressing three critical issues in advanced prostate cancerâmedical versus surgical castration, the role of total androgen blockade with castration plus nonsteroidal antiandrogens, and the optimal timing of any of theseâis timely and appropriate. Substantial attention has been directed at potential biases in the reporting and funding of cost-effectiveness analyses of pharmaceutical agents (3,4). Identifying such biases has been easier since de facto national standards were established by the 1996 U.S. Public Health Serviceâs Panel on Cost-effectiveness in Health and Medicine (5). This report, commissioned by a federal agency (the Agency for Healthcare Research and Quality) at the request of the Health Care Finance Administration (Medicare), has an unusual potential bias: It assumes that the governmentâs perspective is aligned with that of societyâi.e., one that incorporates all costs and effects regardless of who incurs them. In this