Economic Evaluation of Traditional Treatments for Localized Prostate Cancer: A 10-Year Cohort Study
Por:
Zamora, V, Bosch, G, Becerra, V, Garin, O, Avila, M, Gutiérrez, C, Suárez, JF, Goñi, A, Macías, V, Mariño, A, Hervás, A, Herruzo, I, Cabrera, P, de León, JP, Sancho, G, Pont, A, Rubio-Valera, M, Alonso, J, Cots, F, Guedea, F, Castells, M, Ferrer, M
Publicada:
1 ene 2025
Resumen:
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
Filiaciones:
Zamora, V:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Bosch, G:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
Pompeu Fabra Univ, Prevent Med & Publ Hlth Training Unit, Agencia Salut Publ Barcelona, Parc de Salut Mar PSMar,ASPB, Barcelona, Spain
Becerra, V:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
Garin, O:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
Avila, M:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
Inst Catala Oncol, Radiat Oncol Dept, Barcelona, Spain
Gutiérrez, C:
Inst Catala Oncol, Radiat Oncol Dept, Barcelona, Spain
Suárez, JF:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Goñi, A:
Inst Onkol, Radiat Oncol Dept, San Sebastian, Spain
Macías, V:
Hosp Univ & Politecn La Fe, Radiat Oncol Dept, Valencia, Spain
Mariño, A:
Ctr Oncol Galicia, Radiat Oncol Dept, La Coruna, Spain
Hervás, A:
Hosp Ramon & Cajal, Radiat Oncol Dept, Madrid, Spain
Herruzo, I:
Hosp Reg Univ Malaga, Radiat Oncol Dept, Malaga, Spain
Cabrera, P:
Hosp Virgen Del Rocio, Radiat Oncol Dept, Seville, Spain
de León, JP:
Fundacio Puigvert, Urol Dept, Barcelona, Spain
Sancho, G:
Hosp Santa Creu & Sant Pau, Radiat Oncol Dept, Barcelona, Spain
Pont, A:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Rubio-Valera, M:
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Inst Recerca St Joan Deu, Hlth Technol Assessment Primary Care & Mental Hlth, Barcelona, Spain
Alonso, J:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
Cots, F:
Hosp Del Mar Res Inst, Epidemiol & Evaluat Res Grp, Barcelona, Spain
Guedea, F:
Inst Catala Oncol, Radiat Oncol Dept, Barcelona, Spain
Castells, M:
Hosp Univ Bellvitge, Urol Dept, Barcelona, Spain
Ferrer, M:
Hosp Del Mar Res Inst, Hlth Serv Res Grp, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
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