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Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy
PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241382/ https://www.ncbi.nlm.nih.gov/pubmed/28115953 http://dx.doi.org/10.5114/jcb.2016.64808 |
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author | Peters, Max Piena, Marjanne A. Steuten, Lotte M.G. van der Voort van Zyp, Jochem R.N. Moerland, Marinus A. van Vulpen, Marco |
author_facet | Peters, Max Piena, Marjanne A. Steuten, Lotte M.G. van der Voort van Zyp, Jochem R.N. Moerland, Marinus A. van Vulpen, Marco |
author_sort | Peters, Max |
collection | PubMed |
description | PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. MATERIAL AND METHODS: A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. RESULTS: Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. CONCLUSIONS: Focal salvage (125)I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity. |
format | Online Article Text |
id | pubmed-5241382 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-52413822017-01-23 Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy Peters, Max Piena, Marjanne A. Steuten, Lotte M.G. van der Voort van Zyp, Jochem R.N. Moerland, Marinus A. van Vulpen, Marco J Contemp Brachytherapy Original Paper PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. MATERIAL AND METHODS: A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. RESULTS: Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. CONCLUSIONS: Focal salvage (125)I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity. Termedia Publishing House 2016-12-27 2016-12 /pmc/articles/PMC5241382/ /pubmed/28115953 http://dx.doi.org/10.5114/jcb.2016.64808 Text en Copyright: © 2016 Termedia Sp. z o. o. http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Peters, Max Piena, Marjanne A. Steuten, Lotte M.G. van der Voort van Zyp, Jochem R.N. Moerland, Marinus A. van Vulpen, Marco Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title | Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title_full | Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title_fullStr | Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title_full_unstemmed | Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title_short | Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy |
title_sort | comparative cost-effectiveness of focal and total salvage (125)i brachytherapy for recurrent prostate cancer after primary radiotherapy |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241382/ https://www.ncbi.nlm.nih.gov/pubmed/28115953 http://dx.doi.org/10.5114/jcb.2016.64808 |
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