Cost-utility of proton therapy in the treatment of localized prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15184-e15184
Author(s):  
Ravi K. Goyal ◽  
Anne-Marie Meyer ◽  
Nathan Christopher Sheets ◽  
Jerome J Federspiel ◽  
William Ruffin Carpenter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Relative Risk ◽  
Proton Therapy ◽  
Cost Effective ◽  
Localized Prostate Cancer ◽  
Sensitivity Analyses ◽  
Threshold Analysis ◽  
Medicare Data

e15184 Background: Proton therapy (PT) has received much public attention due to its higher costs and lack of evidence of clinical benefit compared to intensity modulated radiation therapy (IMRT) for prostate cancer treatment. In this economic study, we performed a threshold analysis to assess the reduction in toxicity that PT would need to achieve compared with IMRT to be considered cost-effective for the treatment of localized prostate cancer. Methods: SEER-Medicare data was used to identify a cohort, aged 66 years or older, receiving IMRT as definitive radiation therapy (n=4,540). We assumed equal disease control efficacy between IMRT and PT and simulated toxicity outcomes and costs using an incidence-based Markov model. The relative risk of composite toxicity, comparing PT to IMRT, was the efficacy parameter studied. Rates of therapy-induced toxicity associated with IMRT were obtained from SEER-Medicare data. Utility values to calculate quality-adjusted life-years (QALY) and costs (in 2011 US dollars) were obtained from the literature and claims data, respectively. Deterministic threshold analysis using a payer perspective and analytic horizon of 4 years post radiation was performed to determine the relative risk thresholds that would result in incremental cost-effectiveness ratios (ICER) of $50,000 and $100,000/QALY for PT versus IMRT. One-way sensitivity analyses were performed with the lowest and highest treatment costs of PT and IMRT. Results: ComparingPT against IMRT, the threshold values for the relative risk of composite toxicity were 0.318 and 0.588 at cost-effectiveness levels of $50,000/QALY and $100,000/QALY, respectively. Sensitivity analyses showed that the relative risk needed to achieve an ICER of 100,000/QALY ranged from 0.79 and 0.40 for the low and high cost estimates of PT, and from 0.47 to 0.72, for the low and high cost estimates of IMRT. Conclusions: Assuming equal disease control, PT would need to result in a 41% reduction in composite toxicity to be considered cost-effective in the treatment of Medicare beneficiaries with localized prostate cancer at a cost-effectiveness threshold of $100,000/QALY.

CyberKnife for prostate cancer: Is it cost-effective?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 87-87 ◽  
Author(s):  
A. Parthan ◽  
N. Pruttivarasin ◽  
D. Taylor ◽  
D. Davies ◽  
G. Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Societal Perspective ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Lifetime Costs

87 Background: The study assessed the cost-effectiveness of CyberKnife (CK) compared to surgery and radiation therapy for the treatment of prostate cancer (PC) from a third-party and societal perspective. Methods: For patients > 65 yrs with localized PC, a Markov model compared treatment with CK, intensity modulated radiation therapy (IMRT), surgery or proton therapy (PT). Following treatment, patients were at risk of long-term toxicity: genitourinary (GU); gastrointestinal (GI); and sexual dysfunction (SD). Long-term toxicity was defined as adverse events >grade 2 on Radiation Therapy Oncology Group scale occurring at least 12 months following treatment. Markov states included all possible combinations of GI, GU, and SD long-term toxicities, no toxicity, and death. During each year patients remained in the same Markov state or died. Costs and utilities were assigned using published sources. Toxicity probabilities were derived using meta-analytical techniques to pool results from multiple studies. It was assumed that long-term disease control would not differ across treatments. The model projected expected lifetime costs and quality adjusted life years (QALYs) for each treatment and incremental cost-effectiveness of CK vs comparators as cost per QALY gained. Costs from societal perspective included lost productivity. Extensive sensitivity analyses were conducted. Results: Surgery was the least expensive treatment option followed by CK. CK patients had higher expected QALYs (8.11) than other treatment options (7.72- 8.06). From a payer perspective, total lifetime costs were $25,904, $22,295, $38,915, and $58,100 for CK, surgery, IMRT and PT, respectively. Incremental cost per QALY gained for CK versus Surgery was $9,200/QALY. Compared to IMRT and PT, CK was less costly and resulted in higher QALYs (dominance). At a threshold of $50,000/QALY, CK was cost effective in 86%, 79%, and 91% of simulations compared to surgery, IMRT, and PT, respectively. From a societal perspective, CK costs $4,200/QALY compared to surgery and remained dominant vs IMRT and PT. Results were most sensitive to costs of surgery and CK. Conclusions: Initial CK costs are higher than surgery, but CK patients have better quality of life. CK patients have lower lifetime costs and higher QALYs than IMRT and PT patients. [Table: see text]

Gastrointestinal toxicities following radiation therapy for localized prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 64-64
Author(s):  
G. L. Lu-Yao ◽  
S. Kim ◽  
D. Moore ◽  
W. Shih ◽  
Y. Lin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Proton Therapy ◽  
Background Radiation ◽  
Early Years ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Gi Toxicity ◽  
3D Crt

64 Background: Radiation therapy (RAD) is commonly employed to treat localized prostate cancer; however, representative data regarding treatment related toxicities compared to conservative management (CM) is sparse. Methods: We performed a population-based cohort study, using Medicare claims data linked to the Surveillance, Epidemiology, and End Results data, to evaluate gastrointestinal (GI) toxicities in men aged 65-85 years treated with either primary RAD or CM for T1-T2 prostate cancer diagnosed in 1992-2005. In this study, only GI toxicities requiring interventional procedures occurring after 6 months of cancer diagnosis were included. Competing risk models were used with the following covariates: year of diagnosis, comorbidity, age, tumor stage, cancer grade, hormone use within 1 year of diagnosis, region, race, poverty and marital status. Results: Among 41,859 patients in this study, 28,021 patients received radiation therapy, 19,287 with external beam radiation therapy (EBRT) alone, and 5,138 with brachytherapy alone. The most common GI toxicity was GI bleeding or ulceration. GI toxicity rates were 6.1% after 3D-conformal therapy (3D-CRT), 2.8% after intensity modulated radiation therapy (IMRT), 2.6% after brachytherapy, 8.2% after proton therapy and 1.1% for CM patients. In the multivariate models, RAD group was associated with a higher hazard of GI toxicities (hazard ratio [HR] 4.68; 95% CI, 3, 93-5.58) than CM. Comparing to 3D-CRT, brachytherapy (HR 0.62; 95% CI, 0.51-0.75) and IMRT (HR 0.67; 95% CI, 0.55-0.82) are associated with a lower hazard of GI toxicities, while proton therapy is associated with a higher hazard of GI toxicities (HR 2.15; 95% CI, 1.45-3.17). Conclusions: Radiation therapy is associated with a higher risk of GI toxicities than CM. Among different modalities of radiation therapy, protons therapy is associated with the highest risk of GI toxicities, followed by 3D-CRT, IMRT, and brachytherapy. The increased GI toxicities for patients with proton therapy may reflect a learning curve in the early years. No significant financial relationships to disclose.

Cost-effectiveness of upfront therapeutic options in low-volume de novo metastatic hormone-sensitive prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 211-211
Author(s):  
Neil Rohit Parikh ◽  
Eric M. Chang ◽  
Nicholas George Nickols ◽  
Matthew Rettig ◽  
Ann C. Raldow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Systemic Therapy ◽  
De Novo ◽  
Cost Effective ◽  
Therapeutic Options ◽  
Oral Drug ◽  
Hormone Sensitive ◽  
Low Volume

211 Background: Low-volume de novo metastatic hormone-sensitive prostate cancer (mHSPC) has historically been treated with lifelong androgen deprivation therapy (ADT). Recently, however, the addition of several advanced therapeutic options – radiation therapy (RT) to the primary, advanced hormonal therapy agents such as abiraterone acetate/prednisone (AAP), and chemotherapy – to ADT have been shown to improve survival in low-volume mHSPC. The objective of this study was to compare the cost-effectiveness of treating low-volume mHSPC patients upfront with RT+ADT, AAP+ADT, or docetaxel+ADT. Methods: A Markov-based cost-effectiveness analysis was constructed comparing three treatment strategies for low-volume mHSPC patients: (1) upfront RT+ADT --> salvage AAP+ADT --> salvage docetaxel+ADT; (2) upfront AAP+ADT --> salvage docetaxel+ADT, and (3) upfront docetaxel+ADT --> salvage AAP+ADT. Transition probabilities were calculated using data from STAMPEDE arms C/G/H, COU-AA-301, COU-AA-302, and TAX-327. RT was delivered via five-fraction stereotactic body radiation therapy. The analysis utilized a 10-year time horizon, and a $100,000/quality adjusted life year (QALY) willingness-to-pay threshold. Utilities were extracted from the literature; costs were taken from Medicare fee schedules and VA oral drug contracts. Results: At 10 years, total cost was $140K, $259K, and $189K, with total QALYs of 4.66, 5.03, and 3.72 for strategies (1) upfront RT+ADT, (2) upfront AAP+ADT, and (3) upfront docetaxel+ADT, respectively. Compared to upfront RT+ADT, upfront AAP+ADT was not cost-effective (ICER: $321K/QALY). This result remained unchanged even after modification of various model inputs in 1-way sensitivity analysis. Upfront docetaxel+ADT was both more costly and less effective than upfront RT+ADT (ICER: -$53K/QALY). Conclusions: At 10 years, RT+ADT is cost-effective compared to other advanced systemic therapy options alone, and should be considered as a viable treatment strategy in all patients with a low-burden of metastatic disease. Additional studies are needed to determine whether any benefit exists in combining RT to the primary with upfront advanced systemic therapy.

scholarly journals Toxicity reduction required for MRI-guided radiotherapy to be cost-effective in the treatment of localized prostate cancer

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200028
Author(s):  
Leif-Erik D Schumacher ◽  
Alan Dal Pra ◽  
Sarah E Hoffe ◽  
Eric A Mellon
Keyword(s):  
Prostate Cancer ◽  
Cost Effective ◽  
Localized Prostate Cancer ◽  
Sensitivity Analyses ◽  
Relative Reduction ◽  
Relative Toxicity ◽  
Toxicity Reduction ◽  
Life Years ◽  
Genitourinary Toxicity ◽  
Mri Guided

Objective: To determine the toxicity reduction required to justify the added costs of MRI-guided radiotherapy (MR-IGRT) over CT-based image guided radiotherapy (CT-IGRT) for the treatment of localized prostate cancer. Methods: The costs of delivering prostate cancer radiotherapy with MR-IGRT and CT-IGRT in conventional 39 fractions and stereotactic body radiotherapy (SBRT) 5 fractions schedules were determined using literature values and cost accounting from two institutions. Gastrointestinal and genitourinary toxicity rates associated with CT-IGRT were summarized from 20 studies. Toxicity-related costs and utilities were obtained from literature values and cost databases. Markov modeling was used to determine the savings per patient for every 1% relative reduction in acute and chronic toxicities by MR-IGRT over 15 years. The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness. One way sensitivity analyses were performed. Standard $100,000 and $50,000 per QALY ratios were used. Results: The added cost of MR-IGRT was $1,459 per course of SBRT and $10,129 per course of conventionally fractionated radiotherapy. Relative toxicity reductions of 7 and 14% are required for SBRT to be cost-effective using $100,000 and $50,000 per QALY, respectively. Conventional radiotherapy requires relative toxicity reductions of 50 and 94% to be cost-effective. Conclusion: From a healthcare perspective, MR-IGRT can reasonably be expected to be cost-effective. Hypofractionated schedules, such a five fraction SBRT, are most likely to be cost-effective as they require only slight reductions in toxicity (7–14%). Advances in knowledge: This is the first detailed economic assessment of MR-IGRT, and it suggests that MR-IGRT can be cost-effective for prostate cancer treatment through toxicity reduction alone.

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