Economic Evaluation of Traditional Treatments for Localized Prostate Cancer: A 10-Year Cohort Study

IF 1.8 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

European Journal of Cancer Care Pub Date : 2025-07-04 DOI:10.1155/ecc/3563061

Víctor Zamora, Guillermo Bosch, Virginia Becerra, Olatz Garin, Mónica Ávila, Cristina Gutiérrez, José Francisco Suárez, Alai Goñi, Víctor Macías, Alfonso Mariño, Asunción Hervás, Ismael Herruzo, Patricia Cabrera, Javier Ponce de León, Gemma Sancho, Àngels Pont, Maria Rubio-Valera, Jordi Alonso, Francesc Cots, Ferran Guedea, Manuel Castells, Montse Ferrer, the Multicentric Spanish Group of Clinically Localized Prostate Cancer

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引用次数: 0

Abstract

Objectives: To perform a cost-effectiveness analysis based on primary data from a cohort of patients with localized prostate cancer followed throughout 10 years, comparing radical prostatectomy, brachytherapy, and external beam radiotherapy (EBRT) and applying disease-specific utilities, from a national health system’s perspective.

Materials and Methods: Patients diagnosed with localized prostate cancer were consecutively recruited in 2003–2005 from 10 Spanish hospitals (n = 674) (ClinicalTrials.gov number: NCT01492751). The expanded prostate cancer index composite (EPIC) and short-form 36 (SF-36) questionnaires were administered through telephone interviews before treatment and annually during follow-up. The outcome measures to evaluate the incremental cost-effectiveness ratio between treatments (ICER) were quality-adjusted life-years (QALYs), calculated by the patient-oriented prostate utility scale (PORPUS) utility index, obtained with a mapping from the EPIC and the SF-36, and survival data. Ten-year medical activities were used to derive costs. Both unweighted and propensity score-weighted analyses were performed.

Results: The weighted mean of 10-year QALYs was the highest for radical prostatectomy (8.53), followed by brachytherapy (8.49) and external radiotherapy (8.20), but the difference was only statistically significant with the latter. Costs were significantly higher for brachytherapy (€21,348) than radical prostatectomy (€12,281) and EBRT (€7,560). Compared to EBRT, the weighted ICER for radical prostatectomy was €14,169/QALY gained and €48,417/QALY for brachytherapy.

Conclusion: Our findings support that radical prostatectomy was the most cost-effective alternative, but the differences in effectiveness among the three treatments were small. The incremental cost of radical prostatectomy and brachytherapy compared to EBRT, however, does not justify restricting these alternatives.

Trial Registration: ClinicalTrials.gov identifier: NCT01492751

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局限性前列腺癌传统治疗方法的经济评价：一项10年队列研究

目的：从国家卫生系统的角度，基于10年随访的局限性前列腺癌患者队列的原始数据，进行成本-效果分析，比较根治性前列腺切除术、近距离治疗和外束放疗（EBRT）以及应用疾病特异性公用事业。材料和方法：2003-2005年从10家西班牙医院连续招募确诊为局限性前列腺癌的患者（n = 674）（ClinicalTrials.gov编号：NCT01492751）。在治疗前和每年随访期间通过电话访谈进行前列腺癌指数扩展复合（EPIC）和简短36 （SF-36）问卷调查。评估治疗间增量成本-效果比（ICER）的结局指标是质量调整生命年（QALYs），由患者导向的前列腺效用量表（PORPUS）效用指数计算，该指数由EPIC和SF-36的映射获得，以及生存数据。采用十年医疗活动来计算费用。进行了未加权和倾向得分加权分析。结果：根治性前列腺切除术的10年QALYs加权平均值最高（8.53），其次是近距离放疗（8.49）和外放疗（8.20），但后者与根治性前列腺切除术的10年QALYs加权平均值差异有统计学意义。近距离治疗的费用（21,348欧元）明显高于根治性前列腺切除术（12,281欧元）和EBRT（7,560欧元）。与EBRT相比，根治性前列腺切除术的加权ICER为14,169欧元/QALY，近距离治疗的加权ICER为48,417欧元/QALY。结论：我们的研究结果支持根治性前列腺切除术是最具成本效益的选择，但三种治疗方法之间的疗效差异很小。然而，与EBRT相比，根治性前列腺切除术和近距离治疗的增量成本并不能证明限制这些替代方案是合理的。试验注册：ClinicalTrials.gov标识符：NCT01492751

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来源期刊

European Journal of Cancer Care 医学-康复医学

CiteScore

4.00

自引率

4.80%

发文量

213

审稿时长

3 months

期刊介绍： The European Journal of Cancer Care aims to encourage comprehensive, multiprofessional cancer care across Europe and internationally. It publishes original research reports, literature reviews, guest editorials, letters to the Editor and special features on current issues affecting the care of cancer patients. The Editor welcomes contributions which result from team working or collaboration between different health and social care providers, service users, patient groups and the voluntary sector in the areas of: - Primary, secondary and tertiary care for cancer patients - Multidisciplinary and service-user involvement in cancer care - Rehabilitation, supportive, palliative and end of life care for cancer patients - Policy, service development and healthcare evaluation in cancer care - Psychosocial interventions for patients and family members - International perspectives on cancer care