1 Department of Epidemiology, Human Genetics, and Environmental Science.
2 Department of Management Policy and Community Health.
J Manag Care Spec Pharm. 2019 Feb;25(2):225-234. doi: 10.18553/jmcp.2019.25.2.225.
No study has investigated the cost and effectiveness of androgen deprivation therapy (ADT) and other curative treatment therapies among the Medicare population, and no study has taken into consideration the long-term side effects associated with ADT.
To examine if adding ADT was cost-effective when accounting for ADT-related long-term side effects in men with prostate cancer.
For this cost-utility analysis, we used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to estimate and compare patient survival, costs from a health payer's perspective, and cost-effectiveness of 3 treatment modalities for advanced prostate cancer patients, including radiation therapy, radiation plus ADT, and active surveillance. We also estimated quality-adjusted life-years (QALYs) by assigning appropriate health state utility values obtained from the literature for each phase of care and for long-term side effects. Propensity score matching was used to control for bias and confounding that were inherent to the observational study design.
Adding ADT to radiation therapy increased median patient survival by 0.71 years. The incremental cost-effectiveness ratio (ICER) for radiation plus ADT versus radiation alone was $63,049 and $295,995 per mean life-year gained for radiation compared with active surveillance, respectively. Treatment-associated adverse side effects substantially reduced QALYs gained. Compared with radiation only, the incremental cost of radiation plus ADT was $127,900 per mean QALY and was nearly 80% cost-effective at a willingness-to-pay threshold of $210,000 per QALY.
Despite ADT-associated costs and long-term side effects, compared with radiation alone, radiation plus ADT was cost-effective at $127,900 per QALY.
This research was supported in part by the Cancer Prevention Research Institute of Texas (grant nos. RP130051 and RP170668). The authors declare that there are no conflicts of interest.
在医疗保险人群中，尚无研究调查雄激素剥夺疗法（ADT）和其他治愈性治疗方法的成本和效果，也没有研究考虑 ADT 相关的长期副作用。
在考虑与 ADT 相关的长期副作用的情况下，检查在前列腺癌男性中添加 ADT 是否具有成本效益。
在这项成本效益分析中，我们使用监测、流行病学和最终结果（SEER）-医疗保险关联数据库来估计和比较 3 种治疗晚期前列腺癌患者的治疗方法的患者生存、从医疗保健支付者角度的成本以及成本效益，包括放射治疗、放射加 ADT 和主动监测。我们还通过为每个护理阶段和长期副作用分配从文献中获得的适当健康状态效用值来估计质量调整生命年（QALY）。使用倾向评分匹配来控制观察性研究设计固有的偏差和混杂因素。
在放射治疗中添加 ADT 可使中位患者生存时间延长 0.71 年。与放射单独治疗相比，放射加 ADT 的增量成本效果比（ICER）分别为 63049 美元和 295995 美元，每增加一个平均寿命年，放射加 ADT 分别为 210000 美元。治疗相关的不良反应严重降低了获得的 QALY。与单独放射治疗相比，放射加 ADT 的增量成本为 127900 美元，每增加一个 QALY 的成本为 127900 美元，在 210000 美元/QALY 的意愿支付阈值下，接近 80%的成本效益。
尽管 ADT 相关成本和长期副作用，但与单独放射治疗相比，放射加 ADT 在每 QALY 127900 美元的成本效益方面具有优势。
本研究部分得到德克萨斯州癌症预防研究所（赠款号 RP130051 和 RP170668）的支持。作者声明不存在利益冲突。
