Decision Analysis of the Benefits and Costs of Screening for Prostate Cancer
Abstract
Over 50% of screen-detected men with low-risk prostate cancer (CaP) are overtreated, and treatment is associated with significant adverse effects (AE). This analysis examines the cost-effectiveness of radical prostatectomy (RP), radiation therapy (IMRT), and brachytherapy (BT) compared with active surveillance (AS) (followed by IMRT if treated) in these men. A Markov Monte Carlo model was constructed: AE of treatment were included. Main outcomes were costs (2008US$), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for men 65, 55, and 75 years of age. AS was most effective at all ages studied. In 65 yo men, it provided 8.38 QALYs at a lifetime cost of $34095. Compared to BT, AS provided an additional 4.2 mo of QALE at an added cost of $3,883 (ICER $11094/QALY). BT was the most effective and least expensive initial therapy, providing an additional 2.5 mo of QALE at a cost savings of $3086 vs. RP. AS was most effective on sensitivity analyses including probability of AE, progressive disease on AS and utilities, and remained cost-effective at all ages analyzed and on all sensitivity analyses. In this model, AS is a cost-effective alternative to initial treatment in men 55-75 in all scenarios analyzed. AS is underutilized in men with screen-detected, low-risk disease.
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 2011
- Accession Number
- ADA554589
Entities
People
- Julia Hayes
Organizations
- Dana–Farber Cancer Institute