Abstract
Introduction: Variable costs of different radiation treatment modalities have played an important factor in selecting the most appropriate treatment for patients with intermediate-risk prostate cancer. Methods: Analysis using a Markov model was conducted to simulate 20-year disease trajectory, quality-adjusted life years (QALYs) and health system costs of a cohort of intermediate-risk prostate cancer patients with mean age of 60 years. Clinical outcomes on toxicity and disease recurrence were measured and a probabilistic sensitivity analysis was performed, varying input parameters simultaneously according to their distributions. Results: Among the six radiation treatment modalities, including conventionally fractionated intensity-modulated radiation therapy (IMRT), hypofractionated IMRT, IMRT combined with high-dose-rate (HDR) brachytherapy, HDR brachytherapy monotherapy, low-dose-rate brachytherapy monotherapy, and stereotactic body radiotherapy (SBRT), SBRT was found to be more cost-effective when compared with LDR-b and other treatment modalities, resulting in an incremental cost–utility ratio of $2985 per QALY. Conclusions: Stereotactic body radiotherapy is the most cost-effective radiation treatment modality in treatment of intermediate-risk prostate cancer, while treatment toxicity and cost data are the key drivers of the cost–utility. Further work is required with long-term follow-up for SBRT.
Highlights
Variable costs of different radiation treatment modalities have played an important factor in selecting the most appropriate treatment for patients with intermediate-risk prostate cancer
In intermediate-risk prostate cancer, which accounts for approximately one-third of all prostate cancer, treatment options have evolved significantly, and different radiation therapies are available to patients
The following treatment modalities are in use at Canadian centres either routinely or under clinical trials: conventionally fractionated intensity-modulated radiotherapy to 78 Gy in 39 fractions [14,15], hypofractionated intensity-modulated radiation therapy (IMRT) to 60 Gy in 20 fractions [15], HDR brachytherapy combined with IMRT (HDR-IMRT) [16,17], HDR brachytherapy monotherapy in two fractions in one implant (HDR-b) [18,19], LDR brachytherapy monotherapy (LDR-b) [20,21], as well as stereotactic body radiotherapy (SBRT) in five fractions [22,23]
Summary
Variable costs of different radiation treatment modalities have played an important factor in selecting the most appropriate treatment for patients with intermediate-risk prostate cancer. Methods: Analysis using a Markov model was conducted to simulate 20-year disease trajectory, quality-adjusted life years (QALYs) and health system costs of a cohort of intermediaterisk prostate cancer patients with mean age of 60 years. Conclusions: Stereotactic body radiotherapy is the most cost-effective radiation treatment modality in treatment of intermediate-risk prostate cancer, while treatment toxicity and cost data are the key drivers of the cost–utility. Treatment choice is often driven by differences in patient and provider preferences that are largely part based on treatment time, cost and toxicity profile. Provide a structured summary of objectives, perspective, setting, methods (including study design and inputs), results (including base case and uncertainty analyses), and conclusions. Present the study question and its relevance for health policy or practice decisions
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