Cost Effectiveness of Primary Radiotherapy Versus Radical Prostatectomy for Intermediate-to-High Risk Prostate Cancer
A partir d'un modèle mathématique, cette étude estime, chez les patients atteints d'un cancer de la prostate à risque intermédiaire ou élevé de récidive, le rapport coût-efficacité de deux stratégies thérapeutiques : l'une combinant radiothérapie et traitement anti-androgénique, l'autre combinant prostatectomie radicale et radiothérapie adjuvante
Résumé en anglais
Introduction : There are no randomized studies to compare the two treatment options for intermediate-to-high risk prostate cancer: 1) Radiation (RT) with androgen deprivation therapy (ADT) or 2) Radical prostatectomy (RP) followed by adjuvant RT for patients with risk factors. This cost-effectiveness analysis compares the quality-adjusted life expectancy (QALE) and cost between these two strategies.
Methods and Materials : Our Markov model allowed patients to transition between health states with yearly probabilities of developing cancer recurrence and/or toxicity. Probabilities were assigned according to favorable intermediate, unfavorable intermediate, or high-risk prostate cancer groups. The primary analysis examined outcomes for patients aged 65 years old, while secondary analyses explored the effects of younger age, elevated baseline cardiovascular risk, and the use of salvage therapy. One-way and probabilistic sensitivity analyses were performed.
Results : Across all primary and secondary analyses, and using wide-range of assumptions, RT + ADT was the preferred treatment strategy for men with intermediate-to-high risk prostate cancer. The QALE was higher after RT + ADT by 0.5 to 1.14 quality-adjusted life years (QALY), compared to RP. RT + ADT was cost effective in all situations, falling beneath a threshold of $100,000 per QALY. Among all risk groups, a greater proportion of patients undergoing RP experienced single or multiple treatment toxicities.
Discussion : RT + ADT may result in improved QALE compared to RP for intermediate-to-high risk prostate cancer. While biochemical failure is similar between treatment groups, there is a higher rate of developing multiple toxicities among patients treated with upfront RP.
