Decision-analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

Boyd, K. A. , Jones, R. J. , Paul, J. , Birrell, F., Briggs, A. H. and Leung, H. Y. (2015) Decision-analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer. BMJ Open, 5(10), e007925. (doi:10.1136/bmjopen-2015-007925) (PMID:26482768) (PMCID:PMC4611206)

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Objective: To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC). Design: Cost-utility analysis using decision analytic modelling by a Markov model. Setting and methods: Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10 000 iteration Monte Carlo simulation. Results: SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29 719 (€37 619) (95% CI −51 985 to −9243). For a ceiling ratio of £30 000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty. Conclusions: The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Paul, Mr James and Leung, Professor Hing and Briggs, Professor Andrew and Jones, Professor Robert and Boyd, Dr Kathleen
Authors: Boyd, K. A., Jones, R. J., Paul, J., Birrell, F., Briggs, A. H., and Leung, H. Y.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN (Online):2044-6055
Published Online:19 October 2015
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in BMJ Open 5(10):e007925
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
508451A randomised controlled trial of deferred androgen deprivation therapy +/- upfront cryotherapy in men with localised radiation recurrent prostate cancer (RRPC) to evaluate efficacy and tolerability.Hing LeungCancer Research UK (CAN-RES-UK)C1381/A12441RI CANCER SCIENCES