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Anido-Herranz U, Fernandez-Calvo O, Ruiz-Bañobre J, Martinez-Breijo S, Fernandez-Nuñez N, Nogareda-Seoane Z, Garrido-Pumar M, Casas-Nebra J, Muñiz-Garcia G, Portela-Pereira P, Gomez-Caamaño A, Perez-Fentes DA, Santome-Couto L, Lázaro M, Molina-Diaz A, Medina-Colmenero A, Vazquez-Estevez S. Outcomes and patterns of use of Radium-223 in metastatic castration-resistant prostate cancer. Front Oncol 2024; 14:1385466. [PMID: 38774416 PMCID: PMC11106362 DOI: 10.3389/fonc.2024.1385466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Radium-223 dichloride (Ra-223) is recommended as a treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral disease, after docetaxel failure, or in patients who are not candidates to receive it. In this study, we aimed to ambispectively analyze overall survival (OS) and prognostic features in mCRPC in patients receiving Ra-223 as per clinical routine practice and identify the most suitable treatment sequence. Patients and methods This study is observational, multicentric, and ambispective. Eligibility criteria included mCRPC patients treated with Ra-223, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, without visceral metastases, and no more than three cm involved lymph nodes. Results A total of 145 patients were included; the median age was 73.97 years, and a Gleason score of more than or equal to 7 in 61 (48%) patients; 73 (81%) had previously received docetaxel. The most important benefit was reached by those patients who received Ra-223 in the second-line setting, with a median OS of 17 months (95% CI, 12-21), and by patients who received six cycles of treatment, with a median OS of 19 months (95% CI, 14-21). An alkaline phosphatase (ALP) decrease was also identified as a prognosis marker. When performing the multivariate analysis, the time to develop castration-resistant disease longer than 24 months was the most important prognostic factor to predict the evolution of the patients receiving Ra-223. Ra-223 was well tolerated, with thrombocytopenia, anemia, and diarrhea being the main adverse events. Conclusion There is a benefit for those patients who received Ra-223 in the second-line setting, regardless of prior use of docetaxel. In addition, a survival benefit for patients presenting with a decline in ALP was observed.
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Affiliation(s)
- Urbano Anido-Herranz
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | | | - Juan Ruiz-Bañobre
- Translational Medical Oncology Group (ONCOMET), Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Department of Medical Oncology, University Clinical Hospital of Santiago de Compostela (SERGAS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Martinez-Breijo
- Department of Urology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | | | - Zulema Nogareda-Seoane
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Garrido-Pumar
- Department of Nuclear Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Gloria Muñiz-Garcia
- Department of Nuclear Medicine – GALARIA, Complexo Hospitalario Universitario Ourense A. S. de Ourense, Ourense, Spain
| | | | - Antonio Gomez-Caamaño
- Department of Radiation Oncology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel Adolfo Perez-Fentes
- Department of Urology, EOXI University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Martín Lázaro
- Department of Medical Oncology, Álvaro Cunqueiro Hospital, Vigo, Spain
| | - Aurea Molina-Diaz
- Department of Medical Oncology, University Clinical Hospital of A Coruña, A Coruña, Spain
| | - Ana Medina-Colmenero
- Department of Medical Oncology, Fundación Centro Oncológico de Galicia, A Coruña, Spain
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Health Care Costs Attributable to Prostate Cancer in British Columbia, Canada: A Population-Based Cohort Study. Curr Oncol 2023; 30:3176-3188. [PMID: 36975453 PMCID: PMC10047657 DOI: 10.3390/curroncol30030240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
We aimed to estimate the total health care costs attributable to prostate cancer (PCa) during care phases by age, cancer stage, tumor grade, and primary treatment in the first year in British Columbia (BC), Canada. Using linked administrative health data, we followed a cohort of men aged ≥ 50 years at diagnosis with PCa between 2010 and 2017 (Cohort 1) from the diagnosis date until the date of death, the last date of observation, or 31 December 2019. Patients who died from PCa after 1 January 2010, were selected for Cohort 2. PCa attributable costs were estimated by comparing costs in patients to matched controls. Cohort 1 (n = 22,672) had a mean age of 69.9 years (SD = 8.9) and a median follow-up time of 5.2 years. Cohort 2 included 6942 patients. Mean PCa attributable costs were the highest during the first year after diagnosis ($14,307.9 [95% CI: $13,970.0, $14,645.8]) and the year before death ($9959.7 [$8738.8, $11,181.0]). Primary treatment with radiation therapy had significantly higher costs each year after diagnosis than a radical prostatectomy or other surgeries in advanced-stage PCa. Androgen deprivation therapy (and/or chemotherapy) had the highest cost for high-grade and early-stage cancer during the three years after diagnosis. No treatment group had the lowest cost. Updated cost estimates could inform economic evaluations and decision-making.
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Xie X, Schaink AK, Liu S, Wang M, Volodin A. Understanding bias in probabilistic analysis in model-based health economic evaluation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:307-319. [PMID: 35610397 DOI: 10.1007/s10198-022-01472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
Guidelines of economic evaluations suggest that probabilistic analysis (using probability distributions as inputs) provides less biased estimates than deterministic analysis (using point estimates) owing to the non-linear relationship of model inputs and model outputs. However, other factors can also impact the magnitude of bias for model results. We evaluate bias in probabilistic analysis and deterministic analysis through three simulation studies. The simulation studies illustrate that in some cases, compared with deterministic analyses, probabilistic analyses may be associated with greater biases in model inputs (risk ratios and mean cost estimates using the smearing estimator), as well as model outputs (life-years in a Markov model). Point estimates often represent the most likely value of the parameter in the population, given the observed data. When model parameters have wide, asymmetric confidence intervals, model inputs with larger likelihoods (e.g., point estimates) may result in less bias in model outputs (e.g., costs and life-years) than inputs with lower likelihoods (e.g., probability distributions). Further, when the variance of a parameter is large, simulations from probabilistic analyses may yield extreme values that tend to bias the results of some non-linear models. Deterministic analysis can avoid extreme values that probabilistic analysis may encounter. We conclude that there is no definitive answer on which analytical approach (probabilistic or deterministic) is associated with a less-biased estimate in non-linear models. Health economists should consider the bias of probabilistic analysis and select the most suitable approach for their analyses.
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Affiliation(s)
- Xuanqian Xie
- Health Technology Assessment Program, Ontario Health, 130 Bloor Street West, 10th floor, Toronto, ON, M5S 1N5, Canada.
| | - Alexis K Schaink
- Health Technology Assessment Program, Ontario Health, 130 Bloor Street West, 10th floor, Toronto, ON, M5S 1N5, Canada
| | - Sichen Liu
- Department of Mathematics and Statistics, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Myra Wang
- Health Technology Assessment Program, Ontario Health, 130 Bloor Street West, 10th floor, Toronto, ON, M5S 1N5, Canada
| | - Andrei Volodin
- Sino-Canada Research Centre of Nonlinear Dynamics and Noise Control, Xiamen University of Technology and the University of Regina, Xiamen University of Technology, Fujian, China.
- Department of Mathematics and Statistics, University of Regina, Regina, SK, S4S 0A2, Canada.
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Cost-Utility Analysis of Radiation Treatment Modalities for Intermediate-Risk Prostate Cancer. ACTA ACUST UNITED AC 2021; 28:2385-2398. [PMID: 34202403 PMCID: PMC8293133 DOI: 10.3390/curroncol28040219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Variable costs of different radiation treatment modalities have played an important factor in selecting the most appropriate treatment for patients with intermediate-risk prostate cancer. METHODS Analysis using a Markov model was conducted to simulate 20-year disease trajectory, quality-adjusted life years (QALYs) and health system costs of a cohort of intermediate-risk prostate cancer patients with mean age of 60 years. Clinical outcomes on toxicity and disease recurrence were measured and a probabilistic sensitivity analysis was performed, varying input parameters simultaneously according to their distributions. RESULTS Among the six radiation treatment modalities, including conventionally fractionated intensity-modulated radiation therapy (IMRT), hypofractionated IMRT, IMRT combined with high-dose-rate (HDR) brachytherapy, HDR brachytherapy monotherapy, low-dose-rate brachytherapy monotherapy, and stereotactic body radiotherapy (SBRT), SBRT was found to be more cost-effective when compared with LDR-b and other treatment modalities, resulting in an incremental cost-utility ratio of $2985 per QALY. CONCLUSIONS Stereotactic body radiotherapy is the most cost-effective radiation treatment modality in treatment of intermediate-risk prostate cancer, while treatment toxicity and cost data are the key drivers of the cost-utility. Further work is required with long-term follow-up for SBRT.
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Hird AE, Magee DE, Cheung DC, Matta R, Kulkarni GS, Nam RK. Abiraterone vs. docetaxel for metastatic hormone-sensitive prostate cancer: A microsimulation model. Can Urol Assoc J 2020; 14:E418-E427. [PMID: 32223875 PMCID: PMC7492043 DOI: 10.5489/cuaj.6234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Our aim was to determine whether androgen deprivation therapy (ADT) with abiraterone acetate (AA) or ADT with docetaxel chemotherapy (DC) resulted in improved quality-adjusted life years (QALYs) among men with de novo metastatic castration-sensitive prostate cancer (mCSPC) and the cost effectiveness of the preferred strategy using decision analytic techniques. METHODS A microsimulation model with a lifetime time horizon was constructed. Our primary outcome was QALYs. Secondary outcomes included cost, incremental cost effectiveness ratio (ICER), unadjusted overall survival (OS), rates of second- and third-line therapy, and adverse events. A systematic literature review was used to generate probabilities and utilities to populate the model. The base case was a 65-year-old patient with de novo mCSPC. RESULTS A total of 100 000 microsimulations were generated. Initial AA resulted in a gain of 0.45 QALYs compared to DC (3.36 vs. 2.91 QALYs) with an ICER of $276 251.82 per QALY gained with initial AA therapy. Median crude OS was 51 months with AA and 48 months with DC. Overall, 46.6% and 42.6% of patients received second-line therapy and 8.7% and 7.9% patients received third-line therapy in the AA and DC groups, respectively. Grade 3/4 adverse events were experienced in 17.6% of patients receiving initial AA and 22.3% of patients receiving initial DC. CONCLUSIONS Although ADT with AA results in a gain in QALYs and crude OS compared to DC, AA therapy is not a cost-effective treatment strategy to apply uniformly to all patients. The availability of AA as a generic medication may help to close this gap. The ultimate choice should be based on patient and tumor factors.
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Affiliation(s)
- Amanda E. Hird
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diana E. Magee
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Douglas C. Cheung
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Girish S. Kulkarni
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Urology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Robert K. Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Parackal A, Tarride JE, Xie F, Blackhouse G, Hoogenes J, Hylton D, Hanna W, Adili A, Matsumoto ED, Shayegan B. Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada. Can Urol Assoc J 2020; 14:E350-E357. [PMID: 32379598 DOI: 10.5489/cuaj.6376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. METHODS Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. RESULTS Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. CONCLUSIONS The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta's HTA recommendation and other economic evaluations, but challenges Ontario's reimbursement decision.
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Affiliation(s)
- Anna Parackal
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada.,McMaster Chair in Health Technology Management, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada.,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jen Hoogenes
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Danielle Hylton
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Wael Hanna
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anthony Adili
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Bobby Shayegan
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Teoh JYC, Hirai HW, Ho JMW, Chan FCH, Tsoi KKF, Ng CF. Global incidence of prostate cancer in developing and developed countries with changing age structures. PLoS One 2019; 14:e0221775. [PMID: 31647819 PMCID: PMC6812812 DOI: 10.1371/journal.pone.0221775] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/14/2019] [Indexed: 11/18/2022] Open
Abstract
To investigate the global incidence of prostate cancer with special attention to the changing age structures. Data regarding the cancer incidence and population statistics were retrieved from the International Agency for Research on Cancer in World Health Organization. Eight developing and developed jurisdictions in Asia and the Western countries were selected for global comparison. Time series were constructed based on the cancer incidence rates from 1988 to 2007. The incidence rate of the population aged ≥ 65 was adjusted by the increasing proportion of elderly population, and was defined as the “aging-adjusted incidence rate”. Cancer incidence and population were then projected to 2030. The aging-adjusted incidence rates of prostate cancer in Asia (Hong Kong, Japan and China) and the developing Western countries (Costa Rica and Croatia) had increased progressively with time. In the developed Western countries (the United States, the United Kingdom and Sweden), we observed initial increases in the aging-adjusted incidence rates of prostate cancer, which then gradually plateaued and even decreased with time. Projections showed that the aging-adjusted incidence rates of prostate cancer in Asia and the developing Western countries were expected to increase in much larger extents than the developed Western countries.
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Affiliation(s)
- Jeremy Y. C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hoyee W. Hirai
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jason M. W. Ho
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Felix C. H. Chan
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kelvin K. F. Tsoi
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- * E-mail: (CFN); (KKFT)
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- * E-mail: (CFN); (KKFT)
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Smith-Palmer J, Takizawa C, Valentine W. Literature review of the burden of prostate cancer in Germany, France, the United Kingdom and Canada. BMC Urol 2019; 19:19. [PMID: 30885200 PMCID: PMC6421711 DOI: 10.1186/s12894-019-0448-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Prostate cancer is the most frequently reported cancer in males in Europe, and is associated with substantial morbidity and mortality. The aim of the current review was to characterize the clinical, economic and humanistic burden of disease associated with prostate cancer in France, Germany, the UK and Canada. METHODS Literature searches were conducted using the PubMed, EMBASE and Cochrane Library databases to identify studies reporting incidence and/or mortality rates, costs and health state utilities associated with prostate cancer in the settings of interest. For inclusion, studies were required to be published in English in full-text form from 2006 onwards. RESULTS Incidence studies showed that in all settings the incidence of prostate cancer has increased substantially over the past two decades, driven in part by increased uptake of prostate specific antigen (PSA) screening leading to earlier identification of tumors, but which has also led to over-treatment, compounding the economic burden of disease. Mortality rates have declined over the same time frame, driven by earlier detection and improvements in treatment. Both prostate cancer itself, as well as treatment and treatment-related complications, are associated with reduced quality of life. CONCLUSIONS Prostate cancer is associated with a significant clinical and economic burden, whilst earlier detection and aggressive treatment is associated with improved survival, over-treatment of men with indolent tumors compounds the already significant burden of disease and treatment can lead to long-term side effects including impotence and impaired urinary and/or bowel function. There is currently an unmet clinical need for diagnostic and/or prognostic tools that facilitate personalized prostate cancer treatment, and potentially reduce the clinical, economic and humanistic burden of invasive cancer treatment.
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Affiliation(s)
- J. Smith-Palmer
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
| | - C. Takizawa
- Genomic Health International, Geneva, Switzerland
| | - W. Valentine
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland
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Li T, Franco-Villalobos C, Proskorovsky I, Sorensen SV, Tran N, Sulur G, Chi KN. Medical resource utilization of abiraterone acetate plus prednisone added to androgen deprivation therapy in metastatic castration-naive prostate cancer: Results from LATITUDE. Cancer 2018; 125:626-632. [PMID: 30521063 DOI: 10.1002/cncr.31847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Abiraterone acetate plus prednisone (AA+P), when added to androgen deprivation therapy (ADT), demonstrated significant improvements in overall survival and disease progression over dual placebos added to ADT in the LATITUDE clinical trial (NCT01715285). The objective of this study was to assess event-driven medical resource utilization (MRU) of ADT plus AA+P (ADT+AA+P) versus ADT plus dual placebos (ADT+placebos) in LATITUDE. METHODS Event-driven MRU data from LATITUDE while patients were on treatment were used for analyses. Types of MRU included overnight hospitalizations and length of stay (LOS), emergency room (ER) visits, radiotherapy, surgery, imaging, and specialist and general practitioner (GP) visits. Rates by treatment (per 100 person-years) and rate ratios comparing ADT+AA+P with ADT+placebos were estimated with zero-inflated Poisson regression. The difference in the average hospital LOS between arms was assessed with repeated measures regression analyses. Reasons for hospitalization were explored. Sensitivity analyses were conducted to assess the robustness of the results. RESULTS A total of 1199 patients were enrolled in LATITUDE. Significantly lower rates of hospitalization (a 24% reduction), imaging (a 36% reduction), and radiotherapy (a 50% reduction) were observed with ADT+AA+P versus ADT+placebos. There was a nonsignificant trend of lower rates of specialist visits and surgery. The rates of ER and GP visits and the average LOS per hospitalization episode were similar across arms. The most common hospitalization reasons were genitourinary, musculoskeletal, and respiratory tract symptoms/disorders. The results remained consistent in a sensitivity analysis. CONCLUSIONS Adding AA+P to ADT does not increase MRU and leads to lower rates of hospitalization, imaging, and radiotherapy. This likely reflects the more favorable clinical outcomes with ADT+AA+P therapy.
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Affiliation(s)
- Tracy Li
- Janssen Global Services, Raritan, New Jersey
| | | | | | | | - NamPhuong Tran
- Janssen Research and Development, Los Angeles, California
| | - Giri Sulur
- Janssen Research and Development, Los Angeles, California
| | - Kim N Chi
- BC Cancer-Vancouver Centre, University of British Columbia, Vancouver, British Columbia, Canada
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Grochtdreis T, König HH, Dobruschkin A, von Amsberg G, Dams J. Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review. PLoS One 2018; 13:e0208063. [PMID: 30517165 PMCID: PMC6281264 DOI: 10.1371/journal.pone.0208063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022] Open
Abstract
Background Treatment of metastatic prostate cancer is associated with high personal and economic burden. Recently, new treatment options for castration-resistant prostate cancer became available with promising survival advantages. However, cost-effectiveness of those new treatment options is sometimes ambiguous or given only under certain circumstances. The aim of this study was to systematically review studies on the cost-effectiveness of treatments and costs of castration-resistant prostate cancer (CRPC) and metastasizing castration-resistant prostate cancer (mCRPC) on their methodological quality and the risk of bias. Methods A systematic literature search was performed in the databases PubMed, CINAHL Complete, the Cochrane Library and Web of Science Core Collection for costs-effectiveness analyses, model-based economic evaluations, cost-of-illness analyses and budget impact analyses. Reported costs were inflated to 2015 US$ purchasing power parities. Quality assessment and risk of bias assessment was performed using the Consolidated Health Economic Evaluation Reporting Standards checklist and the Bias in Economic Evaluations checklist, respectively. Results In total, 38 articles were identified by the systematic literature search. The methodological quality of the included studies varied widely, and there was considerable risk of bias. The cost-effectiveness treatments for CRPC and mCRPC was assessed with incremental cost-effectiveness ratios ranging from dominance for mitoxantrone to $562,328 per quality-adjusted life year gained for sipuleucel-T compared with prednisone alone. Annual costs for the treatment of castration-resistant prostate cancer ranged from $3,067 to $77,725. Conclusion The cost-effectiveness of treatments of CRPC strongly depended on the willingness to pay per quality-adjusted life year gained/life-year saved throughout all included costs-effectiveness analyses and model-based economic evaluations. High-quality cost-effectiveness analyses based on randomized controlled trials are needed in order to make informed decisions on the management of castration-resistant prostate cancer and the resulting financial impact on the healthcare system.
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Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Dobruschkin
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunhild von Amsberg
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Garbens A, Wallis CJD, Matta R, Kodama R, Herschorn S, Narod S, Nam RK. The cost of treatment and its related complications for men who receive surgery or radiation therapy for prostate cancer. Can Urol Assoc J 2018; 13:E236-E248. [PMID: 30526806 DOI: 10.5489/cuaj.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to examine the costs related to treatment and treatment-related complications for patients treated with surgery or radiation for localized prostate cancer. METHODS We performed a population-based, retrospective cohort study of men who underwent open radical prostatectomy or radiation from 2004-2009 in Ontario, Canada. Costs, including initial treatment and inpatient hospitalization, emergency room visit, outpatient consultation, physician billings, and medication costs, were determined for five years following treatment using a validated costing algorithm. Multivariable negative binomial regression was used to assess the association between treatment modality and costs. RESULTS A total of 28 849 men underwent treatment for localized prostate cancer from 2004- 2009. In the five years following treatment, men who underwent radiation (n=12 675) had 21% higher total treatment and treatment-related costs than men who underwent surgery ($16 716/person vs. $13 213/person). Based on multivariable analysis, while men who underwent XRT had a lower relative cost in their first year after treatment (relative rate [RR] 0.97; 95% confidence interval [CI] 0.94-1.0; p=0.025), after year 2, annual costs were significantly higher in the radiation group compared to the surgery group (total cost for year 5, RR 1.44; 95% CI 1.17-1.76; p<0.0001). Our results were similar when restricted to young, healthy men and to older men. CONCLUSIONS Men who undergo radiation have significantly higher five-year total treatment-related costs compared to men who undergo open radical prostatectomy. While surgery was associated with slightly higher initial costs, radiotherapy had higher costs in subsequent years.
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Affiliation(s)
- Alaina Garbens
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Steven Narod
- Women's College Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
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12
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Neumann PJ, Kim DD, Trikalinos TA, Sculpher MJ, Salomon JA, Prosser LA, Owens DK, Meltzer DO, Kuntz KM, Krahn M, Feeny D, Basu A, Russell LB, Siegel JE, Ganiats TG, Sanders GD. Future Directions for Cost-effectiveness Analyses in Health and Medicine. Med Decis Making 2018; 38:767-777. [DOI: 10.1177/0272989x18798833] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. In 2016, the Second Panel on Cost-effectiveness in Health and Medicine updated the seminal work of the original panel from 2 decades earlier. The Second Panel had an opportunity to reflect on the evolution of cost-effectiveness analysis (CEA) and to provide guidance for the next generation of practitioners and consumers. In this article, we present key topics for future research and policy. Methods. During the course of its deliberations, the Second Panel discussed numerous topics for advancing methods and for improving the use of CEA in decision making. We identify and consider 7 areas for which the panel believes that future research would be particularly fruitful. In each of these areas, we highlight outstanding research needs. The list is not intended as an exhaustive inventory but rather a set of key items that surfaced repeatedly in the panel’s discussions. In the online Appendix , we also list and expound briefly on 8 other important topics. Results. We highlight 7 key areas: CEA and perspectives (determining, valuing, and summarizing elements for the analysis), modeling (comparative modeling and model transparency), health outcomes (valuing temporary health and path states, as well as health effects on caregivers), costing (a cost catalogue, valuing household production, and productivity effects), evidence synthesis (developing theory on learning across studies and combining data from clinical trials and observational studies), estimating and using cost-effectiveness thresholds (empirically representing 2 broad concepts: opportunity costs and public willingness to pay), and reporting and communicating CEAs (written protocols and a quality scoring system). Conclusions. Cost-effectiveness analysis remains a flourishing and evolving field with many opportunities for research. More work is needed on many fronts to understand how best to incorporate CEA into policy and practice.
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Affiliation(s)
- Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - David D. Kim
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Thomas A. Trikalinos
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Brown University, Providence, RI
| | | | - Joshua A. Salomon
- Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University, Stanford, CA
| | - Lisa A. Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, and Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Douglas K. Owens
- VA Palo Alto Health Care System, Palo Alto, CA, and Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University, Stanford, CA
| | - David O. Meltzer
- Departments of Medicine and Economics, Harris School of Public Policy Studies, and Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - Karen M. Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGRI), University of Toronto, Toronto, Ontario, Canada
| | - David Feeny
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, Department of Health Services and Economics, University of Washington, Seattle, WA
| | - Louise B. Russell
- Department of Medical Ethics and Health Policy/Perelman School of Medicine, Center for Health Incentives and Behavioral Economics, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Theodore G. Ganiats
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
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13
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Norum J, Nieder C. Treatments for Metastatic Prostate Cancer (mPC): A Review of Costing Evidence. PHARMACOECONOMICS 2017; 35:1223-1236. [PMID: 28756597 DOI: 10.1007/s40273-017-0555-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC). OBJECTIVES We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers. METHODS A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed® search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In most studies, cabazitaxel was not recommended, because of high cost. Looking at bone-targeting drugs, generic zoledronic acid (ZA) was recommended. External beam radiotherapy (EBRT) was analysed in three studies, and single fraction radiotherapy was concluded to be cost saving. Radium-223 was documented as beneficial, but costly. The quality of the studies was generally good, but sensitivity analyses, discounting and the measurement of health outcomes were present in less than two thirds of the selected studies. CONCLUSIONS The treatment of mCRPC was associated with significant cost. In the post-docetaxel setting, single fraction radiotherapy and enzalutamide were considered cost-effective in most studies. Generic ZA was the recommended bone-targeting therapy.
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Affiliation(s)
- Jan Norum
- Department of Surgery, Finnmark Hospital Trust, 9600, Hammerfest, Norway.
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, 9037, Tromsø, Norway
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
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14
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Gordon LG, Tuffaha HW, James R, Keller AT, Lowe A, Scuffham PA, Gardiner RA. Estimating the healthcare costs of treating prostate cancer in Australia: A Markov modelling analysis. Urol Oncol 2017; 36:91.e7-91.e15. [PMID: 29169847 DOI: 10.1016/j.urolonc.2017.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To estimate the health system costs of prostate cancer by disease risk category and treatment type over 2016 to 2025 and to identify potential strategies to contain the cost increase. METHODS A Markov cohort model was developed using clinical pathways from US prostate cancer guidelines and clinical expertise. Estimates of the probabilities of various treatments and outcomes and their unit costs were sourced from systematic reviews, meta-analyses, epidemiological publications and national cost reports. Estimated costs by stage of disease, by major treatments and by age at diagnosis were reported in 2016 US dollars. One-way and probabilistic sensitivity analyses assessed potential variation in the modeled costs. RESULTS Australia-wide costs of prostate cancer were estimated at US$270.9 million in 2016 rising to US$384.3 million in 2025, an expected increase of 42%. Of this total increase, newly diagnosed low risk cases will contribute US$32.9 million, intermediate-risk US$56.8 million, high-risk US$53.3 million and advanced US$12.6 million. For men diagnosed at age 65 with low-risk disease, lifetime costs per patient were US$14,497 for surgery, US$19,665 for radiation therapies to the primary lesion, and US$9,234 for active surveillance. For intermediate- or high-risk disease, mean costs per patient were US$34,941 for surgery plus radiation and US$31,790 for androgen deprivation therapy plus radiation while advanced cancer therapies were at US$31,574 per patient. Additional costs for managing iatrogenic disease secondary to these treatments were excluded. CONCLUSION Strategies for identifying patients early before cancers have spread are critical to contain the estimated 42% increase in costs over the next decade. Increased uptake of active surveillance would also lead to substantial cost-savings in the management of low-risk prostate cancer.
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Affiliation(s)
- Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Haitham W Tuffaha
- Griffith University, Menzies Health Institute Queensland, Center for Applied Health Economics, Brisbane, Queensland, Australia
| | - Robbie James
- Griffith University, Menzies Health Institute Queensland, Center for Applied Health Economics, Brisbane, Queensland, Australia
| | - Andrew T Keller
- Department of Urology, Queensland Health, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Anthony Lowe
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia; Griffith University, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Paul A Scuffham
- Griffith University, Menzies Health Institute Queensland, Center for Applied Health Economics, Brisbane, Queensland, Australia
| | - Robert A Gardiner
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland, School of Medicine, Center for Clinical Research, Brisbane, Queensland, Australia
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15
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Cronin P, Kirkbride B, Bang A, Parkinson B, Smith D, Haywood P. Long-term health care costs for patients with prostate cancer: a population-wide longitudinal study in New South Wales, Australia. Asia Pac J Clin Oncol 2016; 13:160-171. [DOI: 10.1111/ajco.12582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Paula Cronin
- Centre for Health Economics Research and Evaluation (CHERE); University of Technology; Sydney Australia
| | - Brent Kirkbride
- Centre for Health Economics Research and Evaluation (CHERE); University of Technology; Sydney Australia
| | - Albert Bang
- Cancer Council NSW; Sydney New South Wales Australia
| | - Bonny Parkinson
- Centre for Health Economics Research and Evaluation (CHERE); University of Technology; Sydney Australia
| | - David Smith
- Cancer Council NSW; Sydney New South Wales Australia
- Menzies Health Institute Queensland; Griffith University; Queensland; Sydney Australia
- Sydney Medical School; The University of Sydney; Sydney Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation (CHERE); University of Technology; Sydney Australia
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16
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Sanyal C, Aprikian AG, Cury FL, Chevalier S, Dragomir A. Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality-adjusted life-year analysis. Cancer 2016; 122:1085-96. [PMID: 26828716 DOI: 10.1002/cncr.29892] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND To the authors' knowledge, the literature to date lacks studies examining lifetime costs and quality-adjusted life-years (QALYs) of prostate cancer (PCa) management strategies that integrate localized and advanced disease. The objective of the current study was to assess lifetime costs and QALYs associated with contemporary PCa management strategies across risk groups by integrating localized and advanced disease. METHODS The authors' validated Markov chain Monte Carlo model was used to predict lifetime direct costs and QALYs. The health states modeled were active surveillance, initial treatments (radical prostatectomy or radiotherapy), PCa recurrence, PCa recurrence free, metastatic castration-resistant prostate cancer, and death (cause specific/other causes). Data regarding treatment distribution, state transition probabilities, adverse effects of management options, costs, utilities, and disutilities were derived from the published literature. RESULTS The total cost per patient for the overall cohort increased from $18,503 at 5 years to $28,032 and $39,143, respectively, at 10 years and 15 years. Furthermore, the results indicated the influence of risk group on total cost, with the high-risk group accruing the maximum per patient cost followed by the intermediate-risk and low-risk groups. Active surveillance was found to confer the most QALYs (12.5 years) and was the least costly strategy ($18,452) for individuals at low risk. For all risk groups, radical prostatectomy was less costly and conferred modestly more QALYs compared with intensity-modulated radiotherapy modalities. CONCLUSIONS Public health care systems in Canada and elsewhere are operating under budget constraints to allocate finite resources. The findings of the current study might inform discussions concerning budget planning to provide health care services.
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Affiliation(s)
| | - Armen G Aprikian
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Fabio L Cury
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Division of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Simone Chevalier
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Alice Dragomir
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
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17
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Bremner KE, Mitsakakis N, Wilson L, Krahn MD. Predicting utility scores for prostate cancer: mapping the Prostate Cancer Index to the Patient-Oriented Prostate Utility Scale (PORPUS). Prostate Cancer Prostatic Dis 2013; 17:47-56. [PMID: 24126796 DOI: 10.1038/pcan.2013.44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Prostate Cancer Index (PCI) is a health profile instrument that measures health-related quality of life with six subscales: urinary, sexual, and bowel function and bother. The Patient-Oriented Prostate Utility Scale (PORPUS-U) measures utility (0=dead and 1=full health). Utility is a preference-based approach to measure health-related quality of life, required for decision analyses and cost-effectiveness analyses. We developed a function to estimate PORPUS-U utilities from PCI scores. METHODS The development data set included 676 community-dwelling prostate cancer (PC) survivors who completed the PCI and PORPUS-U by mail. We fit three linear regression models: one used original PORPUS-U scores and two used log-transformed PORPUS-U scores, one with a hierarchy constraint and one without. The model selection was performed using stepwise selection and fivefold cross validation. The validation data included 248 PC outpatients with three assessments on the PCI and PORPUS-U. Scores were retransformed for validation, with Duan's smearing estimator applied to correct potential bias. The predictive ability of the models was assessed with R(2), root mean square error (RMSE) and by comparing predicted and observed utilities. RESULTS The best-fitting model used the log-transformed PORPUS-U with no hierarchy constraint. The R(2) was 0.72. The RMSE ranged from 0.040 to 0.061 for the three validation data sets. Differences between predicted and observed utilities ranged from 0.000 to 0.006 but predicted utilities overestimated the lowest 5% of observed PORPUS-U scores and underestimated the highest observed scores. CONCLUSIONS Our algorithm can calculate PORPUS-U utility scores from PCI scores, thus supplementing descriptive quality of life measures with utility scores in PC patients. Utilities derived from mapping algorithms are useful for assigning utility to groups of patients but are less accurate at predicting utility of individual patients. We are exploring statistical methods to improve the mapping of utilities from descriptive instruments.
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Affiliation(s)
- K E Bremner
- 1] Toronto General Hospital, Clinical Decision Making and Health Care, University Health Network, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, Ontario, Canada
| | - N Mitsakakis
- Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, Ontario, Canada
| | - L Wilson
- Faculty of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - M D Krahn
- 1] Toronto General Hospital, Clinical Decision Making and Health Care, University Health Network, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative (THETA), Toronto, Ontario, Canada [3] Department of Medicine, Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [4] Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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18
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de Oliveira C, Bremner KE, Ni A, Alibhai SMH, Laporte A, Krahn MD. Patient time and out-of-pocket costs for long-term prostate cancer survivors in Ontario, Canada. J Cancer Surviv 2013; 8:9-20. [PMID: 23975612 DOI: 10.1007/s11764-013-0305-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/06/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE Time and out-of-pocket (OOP) costs can represent a substantial burden for cancer patients but have not been described for long-term cancer survivors. We estimated these costs, their predictors, and their relationship to financial income, among a cohort of long-term prostate cancer (PC) survivors. METHODS A population-based, community-dwelling, geographically diverse sample of long-term (2-13 years) PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physicians. We obtained data on demographics, health care resource use, and OOP costs through mailed questionnaires and conducted chart reviews to obtain clinical data. We compared mean annual time and OOP costs (2006 Canadian dollars) across clinical and sociodemographic characteristics and examined the association between costs and four groups of predictors (patient, disease, system, symptom) using two-part regression models. RESULTS Patients' (N = 585) mean age was 73 years; 77 % were retired, and 42 % reported total annual incomes less than $40,000. Overall, mean time costs were $838/year and mean OOP costs were $200/year. Although generally low, total costs represented approximately 10 % of income for lower income patients. No demographic variables were associated with costs. Radical prostatectomy, younger age, poor urinary function, current androgen deprivation therapy, and recent diagnosis were significantly associated with increased likelihood of incurring any costs, but only urinary function significantly affected total amount. CONCLUSIONS Time and OOP costs are modest for most long-term PC survivors but can represent a substantial burden for lower income patients. Even several years after diagnosis, PC-specific treatments and treatment-related dysfunction are associated with increased costs. IMPLICATIONS FOR CANCER SURVIVORS Time and out-of-pocket costs are generally manageable for long-term PC survivors but can be a significant burden mainly for lower income patients. The effects of PC-specific, treatment-related dysfunctions on quality of life can also represent sources of expense for patients.
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Affiliation(s)
- Claire de Oliveira
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T414, Toronto, Ontario, M5S 2S1, Canada,
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