Abstract
Objective: To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer. Methods: A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publicly available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY) gained between treatments. Analyses were conducted from both payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed. Results: Compared to intensity-modulated radiation therapy (IMRT) and proton beam therapy (PT), stereotactic body radiation therapy (SBRT) was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost-effective in 75% and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75% and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates. Conclusion: Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.
Highlights
The National Cancer Institute estimates that 241,740 new cases of prostate cancer will be diagnosed in 2012, along with 28,170 deaths (National Cancer Institute, 2012)
The objective of this study is to address this gap by developing a decision analysis model that integrates currently available published evidence on the post-treatment incidence of long-term toxicities to compare the incremental cost-effectiveness of three modern external beam radiation therapies for localized prostate cancer: intensity-modulated radiation therapy (IMRT), proton beam therapy (PT), and stereotactic body radiation therapy (SBRT)
IMRT and PT were both more costly and yielded fewer qualityadjusted life year (QALY) when compared with SBRT
Summary
Based on a review of the current published literature, there are several options for patients diagnosed with clinically localized prostate cancer including active surveillance, surgery, and radiation therapy. The objective of this study is to address this gap by developing a decision analysis model that integrates currently available published evidence on the post-treatment incidence of long-term toxicities to compare the incremental cost-effectiveness of three modern external beam radiation therapies for localized prostate cancer: intensity-modulated radiation therapy (IMRT), proton beam therapy (PT), and stereotactic body radiation therapy (SBRT). Intensity-modulated radiation therapy, which is a commonly used treatment for patients with localized prostate cancer, involves the external delivery of multiple beams of radiation that conform to the shape of the tumor, and where the intensity of each beam can be modulated in order to spare surrounding healthy tissue. A study conducted by Konski et al (2007) found that PT was not a cost-effective www.frontiersin.org
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