Decision Analysis of the Benefits and Costs of Screening for Prostate Cancer
Abstract
Observation has emerged as a strategy to avoid overtreatment in men with screen-detected low-risk prostate cancer (CaP). This analysis examines the cost-effectiveness of observation with watchful waiting (WW) or active surveillance (AS), radical prostatectomy (RP), radiation therapy (IMRT), and brachytherapy (BT) in these men. METHODS: A Markov Monte Carlo model was constructed: adverse effects (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. RESULTS: In 65 year old men, AS was associated with the greatest QALE but at $35,201 was more expensive than brachytherapy(ICER $15,420/QALY); RP and IMRT were dominated. In 55 and 75 year old men these ICERs were $8,374/QALY and $8,671/QALY, respectively. When costs of treatment of adverse effects were doubled, AS became least expensive in all men. When the PIVOT trial was simulated, WW was cost-saving compared with AS and RP and remained less expensive and associated with improved QALE over a wide range of cost and utilities, including if the risk of CaP-specific death on AS was 50% the risk on WW. CONCLUSIONS: In this model, observation is a cost-effective alternative to initial treatment and is underutilized in these men.
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 2012
- Accession Number
- ADA566502
Entities
People
- Julia H. Hayes
Organizations
- Dana–Farber Cancer Institute