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Cross T, McPhail S. Prostate Cancer: Diagnosis and Treatment (Supplement): An Assessment of Need [Internet]. Cardiff (UK): National Collaborating Centre for Cancer (UK); 2008 Feb. (NICE Clinical Guidelines, No. 58S.)

Cover of Prostate Cancer: Diagnosis and Treatment (Supplement)

Prostate Cancer: Diagnosis and Treatment (Supplement): An Assessment of Need [Internet].

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6Hormonal therapy

Prescription data was provided by Intercontinental Medical Statistics Health Medical Data Index39. This gives the numbers of prescriptions for luteinising hormone-releasing hormone (LHRH) agonists, anti-androgens and oestrogen derivatives written for prostate cancer patients in 125 GP practices. These figures are projected to the population of England and Wales to estimate the total number of prescriptions.

Data on the number of prescriptions dispensed is also available from the NHS Business Services Authority Prescription Pricing Divison (NHSBSA PPD). This is available by British National Formulary (BNF) category but is not tied specifically to a diagnosis of prostate cancer. PPD data covers the number of prescriptions dispensed in primary care. Data presented in this section may therefore be seen as a lower bound estimate of hormone prescriptions for prostate cancer. An upper bound estimate may be derived by multiplying figures by the appropriate factor in Table 6.1.

Table 6.1. Fraction of prescriptions in 2000–2004 from IMS Health Medical Data Index compared to NHSBSA PPD data.

Table 6.1

Fraction of prescriptions in 2000–2004 from IMS Health Medical Data Index compared to NHSBSA PPD data.

Hormonal therapy prescriptions have increased dramatically since the mid-1980s (Figure 6.1). Anti-androgen prescriptions rose from zero prior to 1983 to approximately 150,000 per annum in 2004. LHRH agonists increased from zero prior to 1986 to over 300,000 in 2004. Oestrogen prescriptions declined between the 1970s and mid 1990s, falling to a minimum of 14,000 prescriptions in 1996. Between 1996 and 2004 there has been a statistically significant (p<0.001, ANOVA) upward trend in oestrogen prescriptions.

Figure 6.1. Number of prescriptions of hormone treatment for prostate cancer patients. Data for 1988 is interpolated.

Figure 6.1

Number of prescriptions of hormone treatment for prostate cancer patients. Data for 1988 is interpolated. Data source: IMS Health Medical Data Index, London.

The majority of the rise in anti-androgen prescriptions since the mid 1990s is due to the use of bicalutamide (Figure 6.2). Prescriptions of cyprotereone acetate peaked in 1993, since then the number of prescriptions have fallen by approximately two thirds. Flutamide has fallen from a peak of approximately 40,000 prescriptions per year in 1996 to no recorded prescriptions in 2004. Between 2002 and 2004 bicalutamide made up 79% of anti-androgen prescriptions with Cyproterone acetate 18%.

Figure 6.2. Number of prescriptions of anti-androgens for prostate cancer patients.

Figure 6.2

Number of prescriptions of anti-androgens for prostate cancer patients. Data source: IMS Health Medical Data Index, London.

Goserelin makes up the majority of the increase in prescription of LHRH agonists (Figure 6.3). Between 2002 and 2004 Goserelin made up 87% of LHRH agonists prescriptions and Leuprorelin 13%.

Figure 6.3. Number of prescriptions of LHRH agonists for prostate cancer patients.

Figure 6.3

Number of prescriptions of LHRH agonists for prostate cancer patients. Data source: IMS Health Medical Data Index, London.

Stilboestrol makes up the majority of oestrogen prescriptions for prostate cancer patients (84% of all prescriptions between 1975 and 2003). (Figure 6.4). In 2004 Estradurin makes up half of the total prescriptions.

Figure 6.4. Number of prescriptions of estrogen treatment for prostate cancer patients. Data for 1988 is interpolated.

Figure 6.4

Number of prescriptions of estrogen treatment for prostate cancer patients. Data for 1988 is interpolated. Data source: IMS Health Medical Data Index, London.

6.1. Estimated cost of hormonal therapy

The NHSBSA PPD provided numbers of prescriptions and cost estimates for anti-androgens and LHRH agonists dispensed in primary care. These were not prostate cancer specific and included hormones dispensed for other medical purposes. The NHSBSA PPD cost estimates were applied to the numbers of prescriptions provided by IMS for prostate-cancer specific prescriptions in order to estimate the cost of prostate cancer specific prescriptions.

The total cost of all prescriptions recorded by the NHSBSA PPD in 2004 was 8.1 £Billion40. Of this 292 £Million was recorded under BNF section 8, “Malignant disease & immunosuppression” with hormone treatment for prostate cancer making up approximately 40%.

Bicalutamide has a higher cost per prescription than Cyproterone acetate or Flutamide. This increases its share of the total cost for LHRH agonists (Figure 6.5) compared to its share of the number of prescriptions (see Figure 6.2).

Figure 6.5. Cost of prescriptions of anti-androgens for prostate cancer patients.

Figure 6.5

Cost of prescriptions of anti-androgens for prostate cancer patients. Data source: IMS Health Medical Data Index, London and PCA data from PPA.

Goserelin has a higher unit cost than Leuprorelin, increasing its share of the total cost for LHRH agonists. (Figure 6.6) compared to its share of the number of prescriptions. (Figure 6.3).

Figure 6.6. Cost of prescriptions of LHRH analogues for prostate cancer patients.

Figure 6.6

Cost of prescriptions of LHRH analogues for prostate cancer patients. Data source: IMS Health Medical Data Index, London and Prescription Cost Analysis data from the PPA.

Department of Health. Prescription Cost Analysis: England 2004. Accessed 8 April 2005 Available online at http://www​.dh.gov.uk​/en/Publicationsandstatistics​/Publications​/PublicationsStatistics/DH_4107504

Footnotes

39

http://research​.imshealth​.com/databases/databases.htm

40

Department of Health. Prescription Cost Analysis: England 2004. Accessed 8 April 2005 Available online at http://www​.dh.gov.uk​/en/Publicationsandstatistics​/Publications​/PublicationsStatistics/DH_4107504

Copyright © 2008, National Collaborating Centre for Cancer.
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