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) as experienced in the PIVOT study or active surveillance (AS), radical prostatectomy (RP), radiation therapy (IMRT), and brachytherapy (BT) in these men. METHODS: A Markov Monte Carlo model was constructed. Main outcomes were costs (2012US$) and quality-adjusted life-years (QALYs) for men aged 65 and 75 years. RESULTS: Observation was more effective and less costly than initial treatment. Compared with AS, WW provided 2 additional months of QALE (9.02 vs. 8.85 y) at a savings of $15374 ($24520 vs. $39894) in men aged 65 and 6.14 vs. 5.98y at a savings of $11746 ($18302 vs. $30048) in men aged 75. BT was the most effective and least expensive initial treatment. Treatment became more effective than observation when it led to greater reductions in CaP death (hazard ratio, 0.47 vs. WW; 0.64 vs. AS). AS became as effective as WW in men aged 65 when the probability of progressing to treatment on AS decreased below 63% or when the quality of life with AS versus WW was 4% higher in men aged 65. WW remained least expensive in all analyses
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 2014
- Accession Number
- ADA610807
Entities
People
- Julia H. Hayes
Organizations
- Dana–Farber Cancer Institute