Health Economics and Outcomes Research OptumInsight.
Front Oncol. 2012 Aug 20;2:81. doi: 10.3389/fonc.2012.00081. eCollection 2012.
To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer.
A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publicly available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY) gained between treatments. Analyses were conducted from both payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed.
Compared to intensity-modulated radiation therapy (IMRT) and proton beam therapy (PT), stereotactic body radiation therapy (SBRT) was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost-effective in 75% and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75% and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates.
Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.
确定几种外部束放射治疗方法治疗局限性前列腺癌患者的成本效益。
采用终生马尔可夫模型，纳入了发生治疗相关长期毒性或死亡的概率。毒性概率源自使用荟萃分析技术的已发表资料。模型中的效用值和成本源自公开的次级资料。模型计算了每例患者的质量调整预期寿命和预期终生成本，并计算了治疗间每获得一个质量调整生命年（QALY）的增量成本比（ICER）。分析从支付方和社会角度进行。进行了单因素和概率敏感性分析。
与调强放疗（IMRT）和质子束治疗（PT）相比，立体定向体部放疗（SBRT）成本更低，QALY 更高。敏感性分析表明，在与毒性和成本参数相关的变化与现有证据一致的情况下，基本情况分析中的结论是稳健的。在支付方视角下，以 5 万美元/QALY 为阈值，SBRT 在 75%和 94%的概率模拟中相对于 IMRT 和 PT 是成本有效的。在社会视角下，以 5 万美元/QALY 为阈值，SBRT 在 75%和 96%的概率模拟中相对于 IMRT 和 PT 是成本有效的。在阈值分析中，在毒性发生率比 SBRT 基本情况发生率高 23%的情况下，SBRT 成本更低，结果更好。
基于每种治疗方式的长期疗效相当的假设，SBRT 是一种有效的策略，与 IMRT 和 PT 相比，可改善局限性前列腺癌的质量调整生存。
