Re: Dutasteride Not a Cost-Effective Way to Prevent Prostate Cancer in Some Men.

[Guest guest]

Chuck Maack wrote:

....

> http://www.utsouthwestern.edu/utsw/cda/dept353744/files/627763.html

>

> Regarding Dr. Yair Lotan’s opinion that dutasteride/Avodart is

> not a cost effective medication to prevent prostate cancer in

> high risk men - has Dr. Lotan studied the half-life of

> dutasteride to recognize that this medication, once reaching

> its effective steady state concentration, can be prescribed in

> its 0.5mg capsule form to be taken every-other day or even

> every-third day and remain just as effective? This would

> reduce the $1400.00 in annual expense shown by Dr. Lotan to as

> low as $467.00 annually or $39.00 per month. Certainly not an

> exorbitant expense.

I guess I'd have to read the original article to figure out what

the good doctor's argument is. I find the whole concept of

evaluating cost effectiveness to be fraught with difficulty.

I did a search for " generic dutasteride " on Google and

immediately came up with sources offering it for " less than $1 "

per pill from Cipla, a very reputable Indian pharmaceutical

manufacturer. See for example:

http://www.dutasteride.com/dutasteride_links.html

These are illegal to buy in the U.S. but are readily available on

the Internet and, to the best of my knowledge, no one has ever

been prosecuted for buying them.

The Indian drug reduces the price to < $31/month. Using Chuck's

reduced dosage technique, that comes to less than $15, or less

than $10 / month.

I don't know if finasteride ( " Proscar " ) works as well as

dutasteride or not. However it's already off patent and

available in legal generics in the US for less than $1 per

day, or less still if divided as above.

Finally, let's look at the concept of " cost effectiveness " .

I think that cost effectiveness is a valid question to ask about

any drug or medical procedure. We can't escape the question

since society cannot afford unlimited medical care for everyone,

regardless of cost. When we have limited health care dollars, we

have to take cost effectiveness into account in making decisions.

But it's not easy.

I should think that, in order to determine whether it's cost

effective, we have to put a value on all of the following:

Cost of treatment for disease that might have been prevented.

Loss of years of a man's life - to himself, his family and

friends, and society.

The pain and suffering of cancer.

I believe that we can agree on outrageous cases. A drug that

saves one man but costs a billion dollars might be an outrageous

case - though maybe not to the man and especially not if he's

Bill Gates or Hosni Mubarak and has billions to burn.

But what about less outrageous cases?

And how should we consider the cost? We've already seen that

part of the issue with dutasteride is not the cost of the drug,

it's the cost of patent protection. Perhaps an argument should

be made, not that dutasteride is not cost effective, but that

patent protection, at least in some cases, is not cost effective.

Why aren't we entitled to ask questions about that?

What if the patent holder of a drug that saves lives decides to

triple the cost, because he can double or triple his profit even

though many people on the drug now die because they can't afford

it? Should we then say the drug is not cost effective? Or

should we say that the patent holder's action is not cost

effective to society, and that we should take legislative action

to make it illegal, thus making the drug cost effective again?

The question of cost effectiveness cannot be reduced to an

analysis of the mathematics of current drug price vs cost of

outcomes. There are personal, social and moral issues involved.

Alan

[Guest guest]

(ka-snippity)

> As to the cost of dutasteride as opposed to finasteride, I was

> providing the comparison to that provided by the author of the

> paper. And yes, I, too, have suggested patients look into

> purchasing their dutasteride from manufacturers in India, since

> it is likely a good majority of the medications and supplements

> sold here in the U.S. have been outsourced to India and other

> countries for manufacture.

I am sure that that is true.

A couple of months ago, I happened to note (without looking for

it) that a certain med purchased from my local pharmacy is

manufactured by the exact same company whose product is offered

direct from India.

Regards,

Steve J

[Guest guest]

Louis Carliner wrote:

> How about the use of these medication for a period of 6 months

> to shrink the prostate when early non-aggressive form of cancer

> has been detected through biopsy before treatment or surgery.

> After the six month or year, a re-biopsy would be done to see

> if there has been significant enough reduction in the detected

> cancer. Then, when more aggressive treatment options are

> undertaken, it is likely that reduction in amount of undesired

> after effects would result. In the case of surgery, incidence

> of urinary incontinence and even erectile nerve damage would be

> greatly reduced. With radiation treatment options, use of a

> three-month course of hormone blockade treatment with its

> dreaded side effects could be avoided in many cases!

> I'm not a medical professional. Does this make sense?

My layman's speculation on your questions is as follows:

For both surgery and radiation the doctors will treat the entire

gland, no matter whether the cancer is only believed to be in a

small part or not. This is done for two reasons:

1. It's impossible to be positive there is no cancer elsewhere

in the prostate.

2. The treatment cannot be repeated without endangering the

patient. It is better to perform one surgery or one

radiation treatment than to come back later and try to do it

again if cancer remains.

There are other " focal " therapies that do use repeated treatments

if necessary on different parts of the prostate. The ones I know

about are cryotherapy and HIFU. However it is my understanding

that neither of those has yet shown the success rates of surgery

or radiation.

Here's are two articles showing results to support ADT given

before surgery can improving outcomes - but only if given for

prolonged periods, longer than three months. The third article

is a literature survey citing some studies that say ADT improves

outcomes and other studies that say it doesn't.

Go figure.

http://www.ncbi.nlm.nih.gov/pubmed/11502453

http://www.ncbi.nlm.nih.gov/pubmed/10569561

http://www.ncbi.nlm.nih.gov/pubmed/17054269

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[Guest guest]

This has often been my fear of for profit medicine - Insurances will continue to cut back on our treatment with reasons like these. I am very aware unless society figures the loss of that life then my insurance company has akready lost money on me. So the sooner I die the better off for them.

I was very suspicious of the results for breast exames. I do not have the time find out who funded the studies and why. The backround of the researchers and who got a swimming installed for free in their back yard.

Tom W

To: ProstateCancerSupport Cc: rachel.donihoo@...Sent: Wed, February 9, 2011 6:42:46 AMSubject: Re: "Dutasteride Not a Cost-Effective Way to Prevent Prostate Cancer in Some Men."

Chuck Maack wrote:...> http://www.utsouthwestern.edu/utsw/cda/dept353744/files/627763.html> > Regarding Dr. Yair Lotan’s opinion that dutasteride/Avodart is> not a cost effective medication to prevent prostate cancer in> high risk men - has Dr. Lotan studied the half-life of> dutasteride to recognize that this medication, once reaching> its effective steady state concentration, can be prescribed in> its 0.5mg capsule form to be taken every-other day or even> every-third day and remain just as effective? This would> reduce the $1400.00 in annual expense shown by Dr. Lotan to as> low as $467.00 annually or $39.00 per month. Certainly not

an> exorbitant expense.I guess I'd have to read the original article to figure out whatthe good doctor's argument is. I find the whole concept ofevaluating cost effectiveness to be fraught with difficulty.I did a search for "generic dutasteride" on Google andimmediately came up with sources offering it for "less than $1"per pill from Cipla, a very reputable Indian pharmaceuticalmanufacturer. See for example:http://www.dutasteride.com/dutasteride_links.htmlThese are illegal to buy in the U.S. but are readily available onthe Internet and, to the best of my knowledge, no one has everbeen prosecuted for buying them.The Indian drug reduces the price to < $31/month. Using Chuck'sreduced dosage technique, that comes to less than $15, or lessthan $10 / month.I don't know if

finasteride ("Proscar") works as well asdutasteride or not. However it's already off patent andavailable in legal generics in the US for less than $1 perday, or less still if divided as above.Finally, let's look at the concept of "cost effectiveness".I think that cost effectiveness is a valid question to ask aboutany drug or medical procedure. We can't escape the questionsince society cannot afford unlimited medical care for everyone,regardless of cost. When we have limited health care dollars, wehave to take cost effectiveness into account in making decisions.But it's not easy.I should think that, in order to determine whether it's costeffective, we have to put a value on all of the following:Cost of treatment for disease that might have been prevented.Loss of years of a man's life - to himself, his family andfriends, and society.The pain and suffering of

cancer.I believe that we can agree on outrageous cases. A drug thatsaves one man but costs a billion dollars might be an outrageouscase - though maybe not to the man and especially not if he'sBill Gates or Hosni Mubarak and has billions to burn.But what about less outrageous cases?And how should we consider the cost? We've already seen thatpart of the issue with dutasteride is not the cost of the drug,it's the cost of patent protection. Perhaps an argument shouldbe made, not that dutasteride is not cost effective, but thatpatent protection, at least in some cases, is not cost effective.Why aren't we entitled to ask questions about that?What if the patent holder of a drug that saves lives decides totriple the cost, because he can double or triple his profit eventhough many people on the drug now die because they can't affordit? Should we then say the drug is not cost

effective? Orshould we say that the patent holder's action is not costeffective to society, and that we should take legislative actionto make it illegal, thus making the drug cost effective again?The question of cost effectiveness cannot be reduced to ananalysis of the mathematics of current drug price vs cost ofoutcomes. There are personal, social and moral issues involved.Alan

[Guest guest]

This has often been my fear of for profit medicine - Insurances will continue to cut back on our treatment with reasons like these. I am very aware unless society figures the loss of that life then my insurance company has akready lost money on me. So the sooner I die the better off for them.

I was very suspicious of the results for breast exames. I do not have the time find out who funded the studies and why. The backround of the researchers and who got a swimming installed for free in their back yard.

Tom W

To: ProstateCancerSupport Cc: rachel.donihoo@...Sent: Wed, February 9, 2011 6:42:46 AMSubject: Re: "Dutasteride Not a Cost-Effective Way to Prevent Prostate Cancer in Some Men."

Chuck Maack wrote:...> http://www.utsouthwestern.edu/utsw/cda/dept353744/files/627763.html> > Regarding Dr. Yair Lotan’s opinion that dutasteride/Avodart is> not a cost effective medication to prevent prostate cancer in> high risk men - has Dr. Lotan studied the half-life of> dutasteride to recognize that this medication, once reaching> its effective steady state concentration, can be prescribed in> its 0.5mg capsule form to be taken every-other day or even> every-third day and remain just as effective? This would> reduce the $1400.00 in annual expense shown by Dr. Lotan to as> low as $467.00 annually or $39.00 per month. Certainly not

an> exorbitant expense.I guess I'd have to read the original article to figure out whatthe good doctor's argument is. I find the whole concept ofevaluating cost effectiveness to be fraught with difficulty.I did a search for "generic dutasteride" on Google andimmediately came up with sources offering it for "less than $1"per pill from Cipla, a very reputable Indian pharmaceuticalmanufacturer. See for example:http://www.dutasteride.com/dutasteride_links.htmlThese are illegal to buy in the U.S. but are readily available onthe Internet and, to the best of my knowledge, no one has everbeen prosecuted for buying them.The Indian drug reduces the price to < $31/month. Using Chuck'sreduced dosage technique, that comes to less than $15, or lessthan $10 / month.I don't know if

finasteride ("Proscar") works as well asdutasteride or not. However it's already off patent andavailable in legal generics in the US for less than $1 perday, or less still if divided as above.Finally, let's look at the concept of "cost effectiveness".I think that cost effectiveness is a valid question to ask aboutany drug or medical procedure. We can't escape the questionsince society cannot afford unlimited medical care for everyone,regardless of cost. When we have limited health care dollars, wehave to take cost effectiveness into account in making decisions.But it's not easy.I should think that, in order to determine whether it's costeffective, we have to put a value on all of the following:Cost of treatment for disease that might have been prevented.Loss of years of a man's life - to himself, his family andfriends, and society.The pain and suffering of

cancer.I believe that we can agree on outrageous cases. A drug thatsaves one man but costs a billion dollars might be an outrageouscase - though maybe not to the man and especially not if he'sBill Gates or Hosni Mubarak and has billions to burn.But what about less outrageous cases?And how should we consider the cost? We've already seen thatpart of the issue with dutasteride is not the cost of the drug,it's the cost of patent protection. Perhaps an argument shouldbe made, not that dutasteride is not cost effective, but thatpatent protection, at least in some cases, is not cost effective.Why aren't we entitled to ask questions about that?What if the patent holder of a drug that saves lives decides totriple the cost, because he can double or triple his profit eventhough many people on the drug now die because they can't affordit? Should we then say the drug is not cost

effective? Orshould we say that the patent holder's action is not costeffective to society, and that we should take legislative actionto make it illegal, thus making the drug cost effective again?The question of cost effectiveness cannot be reduced to ananalysis of the mathematics of current drug price vs cost ofoutcomes. There are personal, social and moral issues involved.Alan