Accession Number ADA566502
Title Decision Analysis of the Benefits and Costs of Screening for Prostate Cancer.
Publication Date Aug 2012
Media Count 13p
Personal Author J. H. Hayes
Abstract Observation has emerged as a strategy to avoid overtreatment in men with screen-detected low-risk prostate cancer (CaP). This analysis examines the cost-effectiveness of observation with watchful waiting (WW) or active surveillance (AS), radical prostatectomy (RP), radiation therapy (IMRT), and brachytherapy (BT) in these men. A Markov Monte Carlo model was constructed: adverse effects (AE) of treatment were included. Main outcomes were costs (2008US$), quality-adjusted life-years (QALYs), and incremental cost- effectiveness ratios (ICERs) for men 65, 55, and 75 years of age. In 65 year old men, AS was associated with the greatest QALE but at $35,201 was more expensive than brachytherapy(ICER $15,420/QALY); RP and IMRT were dominated. In 55 and 75 year old men these ICERs were $8,374/QALY and $8, 671/QALY, respectively. When costs of treatment of adverse effects were doubled, AS became least expensive in all men. When the PIVOT trial was simulated, WW was cost-saving compared with AS and RP and remained less expensive and associated with improved QALE over a wide range of cost and utilities, including if the risk of CaP-specific death on AS was 50% the risk on WW. In this model, observation is a cost-effective alternative to initial treatment and is underutilized in these men.
Keywords Cancer screening
Cost effectiveness
Decision theory
Monte carlo method
Prostate cancer
Radiotherapy


 
Source Agency Non Paid ADAS
NTIS Subject Category 96A - Domestic Commerce, Marketing, & Economics
57A - Anatomy
57S - Physiology
57E - Clinical Medicine
Corporate Author Dana-Farber Cancer Inst., Boston, MA.
Document Type Technical report
Title Note Annual summary 27 Jul 2011-26 Jul 2012.
NTIS Issue Number 1307
Contract Number W81XWH-09-1-0512

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