Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Australia; Department of Urology, Frankston Hospital, Frankston, Australia; Division of Urology, Royal Melbourne Hospital, Melbourne, Australia.
Value Health. 2021 Dec;24(12):1737-1745. doi: 10.1016/j.jval.2021.06.004. Epub 2021 Jul 29.
To estimate the lifetime health and economic outcomes of selecting active surveillance (AS), radical prostatectomy (RP), or radiation therapy (RT) as initial management for low- or favorable-risk localized prostate cancer.
A discrete-event simulation model was developed using evidence from published randomized trials. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Costs were included from a public payer perspective in Australian dollars. Outcomes were discounted at 5% over a lifetime horizon. Probabilistic and scenario analyses quantified parameter and structural uncertainty.
A total of 60% of patients in the AS arm eventually received radical treatment (surgery or radiotherapy) compared with 90% for RP and 91% for RT. Although AS resulted in fewer treatment-related complications, it led to increased clinical progression (AS 40.7%, RP 17.6%, RT 19.9%) and metastatic disease (AS 13.4%, RP 6.1%, RT 7.0%). QALYs were 10.88 for AS, 11.10 for RP, and 11.13 for RT. Total costs were A$17 912 for AS, A$15 609 for RP, and A$15 118 for RT. At a willingness to pay of A$20 000/QALY, RT had a 61.4% chance of being cost-effective compared to 38.5% for RP and 0.1% for AS.
Although AS resulted in fewer and delayed treatment-related complications, it was not found to be a cost-effective strategy for favorable-risk localized prostate cancer over a lifetime horizon because of an increase in the number of patients developing metastatic disease. RT was the dominant strategy yielding higher QALYs at lower cost although differences compared with RP were small.
评估主动监测（AS）、根治性前列腺切除术（RP）或放射治疗（RT）作为低危或中危局限性前列腺癌初始治疗的终生健康和经济结局。
使用来自已发表随机试验的证据，开发了一个离散事件模拟模型。健康结果以寿命年和质量调整寿命年（QALY）来衡量。从澳大利亚公共支付者的角度纳入了成本。在终生范围内，对结果进行了 5%的贴现。概率和情景分析量化了参数和结构不确定性。
AS 组中共有 60%的患者最终接受了根治性治疗（手术或放疗），而 RP 组为 90%，RT 组为 91%。尽管 AS 导致治疗相关并发症较少，但导致临床进展（AS 为 40.7%，RP 为 17.6%，RT 为 19.9%）和转移性疾病（AS 为 13.4%，RP 为 6.1%，RT 为 7.0%）的比例增加。AS 的 QALY 为 10.88，RP 为 11.10，RT 为 11.13。AS 的总成本为 17912 澳元，RP 为 15609 澳元，RT 为 15118 澳元。在愿意支付 20000 澳元/QALY 的情况下，与 RP 相比，RT 具有 61.4%的成本效益概率，而 AS 仅为 0.1%。
尽管 AS 导致治疗相关并发症更少且更延迟，但由于转移性疾病患者数量增加，在终生范围内，它并不是一种针对中危局限性前列腺癌的具有成本效益的策略。尽管与 RP 相比差异较小，但 RT 是一种更优的策略，其具有更高的 QALY 和更低的成本。
