Prognostic Testing for Prostate Cancer-A Cost-Effectiveness Analysis Comparing a Prostatype P-Score Biomarker Approach to Standard Clinical Practice.

IF 4.4 3区医学 Q1 ECONOMICS

PharmacoEconomics Pub Date : 2025-01-11 DOI:10.1007/s40273-024-01466-9

Adam Fridhammar, Oskar Frisell, Karin Wahlberg, Emelie Berglund, Pontus Röbeck, Sofie Persson

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引用次数: 0

Abstract

Background: The Prostatype score (P-score) is a prognostic biomarker that integrates a three-gene (IGFBP3, F3, and VGLL3) signature derived from prostate biopsy samples, with key clinical parameters, including prostate-specific antigen (PSA) levels, Gleason grade, and tumor stage at diagnosis. The test has demonstrated superior predictive accuracy for prostate cancer outcomes compared with traditional risk categorization systems such as D'Amico. Notably, it reclassifies a higher proportion of patients into the low-risk category, making them eligible for active surveillance. This study assessed the cost-effectiveness of the P-score in comparison with D'Amico and the Swedish National Prostate Cancer Register (NPCR) risk categorization systems.

Methods: A two-step decision analytic model was developed. The model consisted of a decision tree-informed Markov structure estimating the lifetime outcomes of 60-year-old men with diagnosed prostate cancer. Prostate cancer was classified as low-risk, intermediate-risk, or high-risk using either the P-score or D'Amico. Initial therapy was based on observed treatment patterns from the Swedish NPCR. Costs (SEK, year 2022) and quality-adjusted life years (QALYs) were estimated from a healthcare perspective and discounted at 3% per year; incremental cost-effectiveness ratio (ICER) was the primary outcome.

Results: The P-score led to cost savings and generated an additional 0.19 QALYs compared with D'Amico. The added costs of the genetic test and higher costs of active surveillance and radiotherapy were counterbalanced by savings from reduced costs of surgery, treatment-related side-effects, and metastatic disease. The gain in QALYs was primarily due to the avoidance of metastatic disease and a reduction in treatment-related side-effects.

Conclusions: The results of this study suggest that the P-score is likely to be a cost-effective alternative to D'Amico for prognostic evaluation of newly diagnosed prostate cancer in Sweden and compared with NPCR when health-related quality of life was included.

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前列腺癌的预后检测：比较前列腺型P-Score生物标志物方法与标准临床实践的成本-效果分析

背景：前列腺类型评分（P-score）是一种预后生物标志物，整合了来自前列腺活检样本的三基因（IGFBP3、F3和VGLL3）特征，具有关键的临床参数，包括前列腺特异性抗原（PSA）水平、Gleason分级和诊断时的肿瘤分期。与传统的风险分类系统（如D'Amico）相比，该测试显示出对前列腺癌结果的预测准确性更高。值得注意的是，它将更高比例的患者重新分类为低风险类别，使他们有资格接受主动监测。本研究评估了p -评分与D'Amico和瑞典国家前列腺癌登记（NPCR）风险分类系统的成本效益。方法：建立两步决策分析模型。该模型由一个决策树马尔可夫结构组成，用于估计诊断为前列腺癌的60岁男性的终生结果。使用P-score或D'Amico将前列腺癌分为低风险、中风险或高风险。初始治疗基于瑞典NPCR观察到的治疗模式。从医疗保健的角度估计成本（瑞典克朗，2022年）和质量调整生命年（QALYs），并以每年3%的折扣计算；增量成本-效果比（ICER）是主要终点。结果：与D'Amico相比，p评分导致了成本节约，并产生了额外的0.19个qaly。基因检测费用的增加以及主动监测和放疗费用的增加被手术、治疗相关副作用和转移性疾病费用的降低所节省的费用所抵消。QALYs的增加主要是由于避免了转移性疾病和治疗相关副作用的减少。结论：本研究结果表明，当纳入健康相关生活质量时，P-score可能是瑞典新诊断前列腺癌的D'Amico预后评估的一种具有成本效益的替代方法，并与NPCR相比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PharmacoEconomics 医学-药学

CiteScore

8.10

自引率

9.10%

发文量

审稿时长

6-12 weeks

期刊介绍： PharmacoEconomics is the benchmark journal for peer-reviewed, authoritative and practical articles on the application of pharmacoeconomics and quality-of-life assessment to optimum drug therapy and health outcomes. An invaluable source of applied pharmacoeconomic original research and educational material for the healthcare decision maker. PharmacoEconomics is dedicated to the clear communication of complex pharmacoeconomic issues related to patient care and drug utilization. PharmacoEconomics offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article.