Academic journal article Applied Health Economics and Health Policy

Systematic Review of the Cost Effectiveness of Radiation Therapy for Prostate Cancer from 2003 to 2013

Academic journal article Applied Health Economics and Health Policy

Systematic Review of the Cost Effectiveness of Radiation Therapy for Prostate Cancer from 2003 to 2013

Article excerpt

Published online: 15 July 2014

© Springer International Publishing Switzerland 2014

Abstract

Background Prostate cancer remains a prevalent diagnosis with a spectrum of treatment choices that offer similar oncologic outcomes but differing side effect profiles and associated costs. As the technology for prostate radiation therapy has advanced, its associated costs have escalated, thus making cost-effectiveness analyses critical to assess the value of competing treatment options, including watchful waiting, surgery, brachytherapy, intensity-modulated radiation therapy (IMRT), 3D-conformal radiation therapy (3D-CRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT).

Objective The aim of this systematic review was to identify articles that performed a cost-effectiveness analysis on different radiation treatment options for localized prostate cancer, summarize their findings, and highlight the main drivers of cost effectiveness.

Methods A literature search was performed on two databases, PubMed and the Cost-Effectiveness Analysis Registry (https://research.tufts-nemc.org/cear4), using search terms that included 'prostate', 'cost effectiveness prostate radiation' and 'cost analysis comparative effectiveness prostate radiation'. Studies were included in this review if the cost data were from 2002 or later, and outcomes reported both cost and effectiveness, preferably including a cost-utility analysis with the outcome of an incremental cost-effectiveness ratio with quality-adjusted life-year (QALY) as the effectiveness measure.

Results There were 14 articles between 2003 and 2013 that discussed cost effectiveness of prostate radiotherapy in men over the age of 65. All but four of the papers were from the US; the others were from Canada and the UK. The majority of the papers used Markov decision analysis and estimated cost from a payer's perspective, usually from Medicare reimbursement data. Assumptions for the model and utilities to calculate QALYs were estimated using published literature at the time of the analysis. Each analysis had a sensitivity analysis to compensate for the uncertainty of the model inputs. The main drivers of cost effectiveness were the cost of the radiation treatment and the differential QALYs accrued because of different treatment-related morbidities. Brachytherapy was consistently found to be more cost effective when compared with surgery and other radiation treatment options. IMRT was cost effective when compared with 3D-CRT. PBT was not found to be cost effective in any of the analyses, mostly due to the high costs of PBT. SBRT was the newest technology that was analyzed, and it was also found to be cost effective compared with IMRT and PBT.

Conclusions Cost-effectiveness research of prostate radiation treatments allows patients, providers, and payers to better understand the true value of each treatment choice. Due to the variation in each of these analyses (e.g., costing, and disease and complication assumptions, etc.), it is difficult to generalize the results. One must be careful in drawing conclusions from these studies and extrapolating to individual patients, particularly with the clear utility dependence seen in the majority of these studies.

1 Introduction

Cost-effectiveness research of localized prostate cancer treatments can have a large impact on healthcare spending due to the high prevalence of prostate cancer and the many treatment options with similar outcomes, yet substantially different costs [1, 2].

Radiation treatment options for patients include brachytherapy or external beam radiation therapy (EBRT), which has evolved in complexity over time from twodimensional conformal radiation therapy (2D-CRT), to three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT). Brachytherapy involves a one-time procedure of inserting radioactive seeds into the prostate gland that will permanently remain in the prostate and emit radiation. …

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