TY - JOUR
T1 - Cost-effectiveness analysis of primary treatments for localised prostate cancer
T2 - A population-based Markov analysis using real-world evidence
AU - Weng, Xiuhua
AU - Zhong, Lixian
AU - Xiang, Pin
AU - Li, Yiyuan
AU - Paciorek, Alan
AU - Dong, Liangliang
AU - Broering, Jeanette
AU - Carroll, Peter R.
AU - Sanda, Martin
AU - Wilson, Leslie
N1 - Funding Information:
This work was supported in part by NIH grant: 5RC1CA146596‐02 ‘Effectiveness of Early Stage Prostate Cancer Treatment’. Funding information
Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - Objective: We evaluate cost-effectiveness of primary treatments for localised prostate cancer by uniquely combining prospectively collected real-world outcomes and costs from UCSF Cancer of Prostate Strategic Urologic Research Endeavor (CaPSURE™). Methods: Markov models assessed cost-effectiveness of radical prostatectomy (RP), brachytherapy, electron beam radiation therapy (EBRT) and brachytherapy with EBRT by risk from US payers perspective over 8 years. Treatment costs included office visits, hospitalisation, procedures, medication and long-term care. Patients' surveyed HRQoL were mapped into utilities. Incremental cost-effectiveness ratios (ICERs) used cost per quality-adjusted life years (QALYs) and willingness-to-pay of $150,000/QALY. Results: Cost-effectiveness analysis (CEA) showed for low-risk prostate cancer, EBRT dominated the lowest cost brachytherapy, but RPns and brachytherapy plus EBRT were cost-effective compared to brachytherapy with ICERs of $18,926 and $41,662 per QALY. In medium-risk patients, RP, EBRT and brachytherapy plus EBRT all were cost-effective compared with brachytherapy, with ICERs of $30,604, $22,588 and $21,627/QALY. In high-risk, brachytherapy dominated all treatments. Procedure cost and utility are driving ICER, but probabilistic sensitivity analysis showed the model was robust across variables. Conclusion: This first CEA combining prospective real-world evidence for HRQOL outcomes with costs shows cost-effectiveness of treatments vary by risk groups, providing new evidence for treatment decisions.
AB - Objective: We evaluate cost-effectiveness of primary treatments for localised prostate cancer by uniquely combining prospectively collected real-world outcomes and costs from UCSF Cancer of Prostate Strategic Urologic Research Endeavor (CaPSURE™). Methods: Markov models assessed cost-effectiveness of radical prostatectomy (RP), brachytherapy, electron beam radiation therapy (EBRT) and brachytherapy with EBRT by risk from US payers perspective over 8 years. Treatment costs included office visits, hospitalisation, procedures, medication and long-term care. Patients' surveyed HRQoL were mapped into utilities. Incremental cost-effectiveness ratios (ICERs) used cost per quality-adjusted life years (QALYs) and willingness-to-pay of $150,000/QALY. Results: Cost-effectiveness analysis (CEA) showed for low-risk prostate cancer, EBRT dominated the lowest cost brachytherapy, but RPns and brachytherapy plus EBRT were cost-effective compared to brachytherapy with ICERs of $18,926 and $41,662 per QALY. In medium-risk patients, RP, EBRT and brachytherapy plus EBRT all were cost-effective compared with brachytherapy, with ICERs of $30,604, $22,588 and $21,627/QALY. In high-risk, brachytherapy dominated all treatments. Procedure cost and utility are driving ICER, but probabilistic sensitivity analysis showed the model was robust across variables. Conclusion: This first CEA combining prospective real-world evidence for HRQOL outcomes with costs shows cost-effectiveness of treatments vary by risk groups, providing new evidence for treatment decisions.
KW - cost
KW - cost-effectiveness analysis
KW - economics
KW - prostate cancer
KW - real-world evidence
KW - utility
UR - http://www.scopus.com/inward/record.url?scp=85139756282&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85139756282&partnerID=8YFLogxK
U2 - 10.1111/ecc.13740
DO - 10.1111/ecc.13740
M3 - Article
C2 - 36239065
AN - SCOPUS:85139756282
VL - 31
JO - European Journal of Cancer Care
JF - European Journal of Cancer Care
SN - 0961-5423
IS - 6
M1 - e13740
ER -