ECONOMIC EVALUATION OF DIAGNOSTIC LOCALIZATION FOLLOWING BIOCHEMICAL PROSTATE CANCER RECURRENCE

2014 ◽  
Vol 30 (4) ◽  
pp. 345-353 ◽  
Author(s):  
Daniel A. Barocas ◽  
Mark E. Bensink ◽  
Kristin Berry ◽  
Zahra Musa ◽  
Carolyn Bodnar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Metastatic Disease ◽  
Specific Antigen ◽  
Base Case ◽  
Diagnostic Strategy ◽  
Potential Cost ◽  
Life Years ◽  
Wide Range

Objectives: The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy.Methods: Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care—using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare.Results: The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24–2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330–44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947–22,372). Results were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity.Conclusion: This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.

Potential cost-effectiveness of a diagnostic that identifies localized versus metastatic prostate cancer in men with biochemical recurrence after radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 229-229
Author(s):  
Mark Eliot Bensink ◽  
Kristin Berry ◽  
Zahra Musa ◽  
Carolyn Bodnar ◽  
Daniel Ari Barocas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Metastatic Disease ◽  
Biochemical Recurrence ◽  
Potential Cost ◽  
System Perspective ◽  
Life Years ◽  
Wide Range

229 Background: Asymptomatic men with low but detectable PSA elevation following radical prostatectomy, often receive costly, burdensome, and potentially damaging salvage radiation therapy with uncertain benefit. A new prostate cancer specific functional imaging technology capable of identifying residual localized disease vs. small volume metastatic disease, to more accurately guide therapy decisions, could be of benefit. As a guide to diagnostic development efforts, the objective of this study was to assess the potential cost-effectiveness of using a novel diagnostic in this way. Methods: A Markov model was built to reflect the life-time natural history of prostate cancer recurrence. The model was used to estimate the incremental impact on costs (US healthcare system perspective) and quality adjusted life years (QALYs) of two alternative strategies: 1) using the new diagnostic to guide therapy vs. 2) usual care - using a combination of CT, MRI and bone scan to guide therapy. Costs were based on estimates from the literature, Medicare reimbursement and expert opinion. Prostate cancer progression, survival, and utilities plus the background risk of all-cause mortality, were obtained from the literature. Base-case diagnostic sensitivity, specificity, and cost were 75%, 90%, and $2,500. Results: The new diagnostic strategy provided an average per patient gain of 1.83 (95% UI: 1.41 - 2.5) QALYs and added cost of $15,600 (95% UI: -$7,000 - 48,800) with an incremental cost-effectiveness ratio of $8,500/QALY (95% UI: -$4,100 - 22,900). Results were most influenced by utility parameters and test performance characteristics however; the new diagnostic provided clinical benefits over a wide range of specificity and sensitivity. Conclusions: This analysis suggests that a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized vs. metastatic disease would be cost-effective by reducing the costs and quality-of-life burden associated with non-beneficial radiation therapy. These results support additional investment in the development and validation of such a diagnostic.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

Cost-effectiveness of a biopsy-based 8-protein prognostic assay to optimize treatment decisions in intermediate-risk early-stage prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 77-77 ◽  
Author(s):  
Joshua A. Roth ◽  
Scott David Ramsey ◽  
Josh John Carlson
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Treatment Decisions ◽  
Base Case ◽  
Health State ◽  
Potential Cost ◽  
Large Shift ◽  
Cancer Aggressiveness ◽  
The Impact

77 Background: Clinico-pathologic factors alone are insufficient to predict the likelihood of progression of Gleason 3+3 and 3+4 prostate cancer at the time of biopsy. As a result, many patients receive treatment, despite having unaggressive tumors. There is a need for tests that provide a clearer picture of risk to enable more individualized treatment decisions. A novel prognostic assay (ProMark) that uses quantitative measurements of protein biomarkers has been validated to predict prostate cancer aggressiveness at the time of biopsy. Our objective was to evaluate the potential cost-effectiveness of using the 8-protein assay to inform treatment decisions. Methods: We developed a simulation model to estimate quality-adjusted life-year (QALY) and cost outcomes for assay and usual care (NCCN guidelines) strategies. The proportion of patients classified as low, intermediate, and high-risk by the assay and guidelines was derived from the assay’s validation study. Treatment distributions, costs, health state utilities, and mortality rates were derived from peer-reviewed literature. The health outcome impacts of the assay strategy come from increased use of active surveillance (AS) vs treatment, and we evaluated a base case increase in AS of 14.5% (vs usual care), and small and large shift scenarios with 7.8% and 20.2% increases, respectively. We calculated the incremental QALYs, costs, and cost-effectiveness ratio in each scenario. Results: The assay strategy was dominant in all scenarios evaluated. In the base case, the assay strategy resulted in 0.04 more QALYs and $700 less in costs. The small and large shift scenarios resulted 0.02 and 0.05 more QALYs, and $5 and $1,300 less in costs, respectively. Cost-effectiveness outcomes were most sensitive to the assay cost, the AS health state utility, and the proportion of low-risk patients receiving AS in usual care. Conclusions: Our results suggest that the 8-protein prognostic assay has the potential to be a cost-effective alternative to usual care in patients with Gleason 3+3 and 3+4 prostate cancer. Future studies will evaluate the impact of the assay on patient and physician treatment choices in real-world settings.

scholarly journals Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Jaclyn Beca ◽  
Habeeb Majeed ◽  
Kelvin K.W. Chan ◽  
Sebastian J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Survival Data ◽  
High Volume ◽  
Base Case ◽  
Castration Resistant Prostate Cancer ◽  
Life Years ◽  
Hormone Sensitive ◽  
The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

scholarly journals A cost-utility analysis of apalutamide for metastatic castration-sensitive prostate cancer

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Ambica Parmar ◽  
Narhari Timilshina ◽  
Urban Emmenegger ◽  
Martin Smoragiewicz ◽  
Beate Sander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Therapeutic Option ◽  
Lifetime Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Base Case ◽  
Scenario Analyses ◽  
Life Years

Introduction: Earlier application of oral androgen receptor-axis-targeted therapies in patients with metastatic castration-sensitive prostate cancer (mCSPC) has established improvements in overall survival, as compared to androgen deprivation therapy (ADT) alone. Recently, the use of apalutamide plus ADT has demonstrated improvement in mCSPC-related mortality, vs. ADT alone, with an acceptable toxicity profile. However, the cost-effectiveness of this therapeutic option remains unknown. Methods: We used a state-transition model with probabilistic analysis to compare apalutamide + ADT, as compared to ADT alone for mCSPC patients over a time horizon of 20 years. Primary outcomes included expected life-years (LY), quality-adjusted life-years (QALY), lifetime cost (2020 Canadian dollars), and incremental cost-effectiveness ratio (ICER). Parameter and model uncertainties were assessed through scenario analyses. Health outcomes and cost were discounted at 1.5%, as per Canadian guidelines. Results: For the base-case analysis, expected LY for ADT and apalutamide plus ADT were 4.11 and 5.56, respectively (incremental LY 1.45). Expected QALYs were 3.51 for ADT and 4.84 for apalutamide plus ADT (incremental QALYs 1.33); expected lifetime cost was $36 582 and $255 633, respectively (incremental cost $219,051). ICER for apalutamide plus ADT, as compared to ADT alone, was $164 700/QALY. Through scenario analysis, price reductions >50% were required for apalutamide in combination with ADT to be considered cost-effective, at a cost-effectiveness threshold of $100 000/QALY. Conclusions: Apalutamide plus ADT is unlikely to be cost-effective from the Canadian healthcare perspective unless there are substantial reductions in the price of apalutamide treatment.

scholarly journals The cost-effectiveness of prostate cancer screening using the Stockholm3 test

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246674 ◽  
Author(s):  
Andreas A. Karlsson ◽  
Shuang Hao ◽  
Alexandra Jauhiainen ◽  
K. Miriam Elfström ◽  
Lars Egevad ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Gleason Score ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Cost Effective ◽  
Psa Test ◽  
Life Years ◽  
The Cost

Objectives The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. Methods We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Results Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. Conclusions Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.

scholarly journals Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lindsay S. Rowe ◽  
Stephanie Harmon ◽  
Adam Horn ◽  
Uma Shankavaram ◽  
Soumyajit Roy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Pet Imaging ◽  
Biochemical Recurrence ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Definitive Treatment ◽  
Pattern Of Failure ◽  
Link Type ◽  
Psma Pet

Abstract Background Prostate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI. Methods PCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose. Results A total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose. Conclusions 18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy. Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.

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