Farah Line, Magne Nicolas, Martelli Nicolas, Sotton Sandrine, Zerbib Marc, Borget Isabelle, Scher Nathaniel, Guetta Thierry, Chargari Cyrus, Bauduceau Olivier, Toledano Alain
Groupe de Recherche et d'accueil en Droit et Economie de la Santé (GRADES) Department, Université Paris Saclay, Châtenay-Malabry, France.
Department of the Innovation Center for Medical Devices, Innovation Center for Medical Devices (CiDM), Hôpital Foch, Suresnes, France.
Front Oncol. 2022 May 24;12:834023. doi: 10.3389/fonc.2022.834023. eCollection 2022.
Prostate cancer is the most common men cancer in France. Continuous progress in oncology led to develop robot-assisted Radical Prostatectomies (rRP) and robot-assisted stereotactic body radiotherapy (rSBRT). The present study aims at comparing economic and clinical impacts of prostate cancer treatments performed either with rSBRT or rRP in France. A Markov model using TreeAge Pro software was chosen to calculate annual costs; utilities and transition probabilities of localized prostate cancer treatments. Patients were eligible for radiotherapy or surgery and the therapeutic decision was a robot-assisted intervention. Over a 10-year period, rSBRT yielded a significantly higher number of quality-adjusted life years than rRP (8.37 vs 6.85). In France, rSBRT seemed more expensive than rRP (€19,475 vs €18,968, respectively). From a societal perspective, rRP was more cost-saving (incremental cost effectiveness ratio = €332/QALY). The model was sensitive to variations of costs of the initial and recurrence state in one-way sensitivity analyses. Robot-assisted stereotactic body radiotherapy seems more cost-effective than Radical Prostatectomy in terms of QALY despite the slightly higher initial cost due to the use of radiotherapy. It would be interesting to conduct comparative quality of life studies in France over longer periods of time.
前列腺癌是法国男性中最常见的癌症。肿瘤学的不断进步促使了机器人辅助根治性前列腺切除术（rRP）和机器人辅助立体定向体部放疗（rSBRT）的发展。本研究旨在比较在法国采用rSBRT或rRP进行前列腺癌治疗的经济和临床影响。选择使用TreeAge Pro软件的马尔可夫模型来计算局限性前列腺癌治疗的年度成本、效用和转移概率。患者符合放疗或手术条件，且治疗决策为机器人辅助干预。在10年期间，rSBRT产生的质量调整生命年数显著高于rRP（分别为8.37和6.85）。在法国，rSBRT似乎比rRP更昂贵（分别为19,475欧元和18,968欧元）。从社会角度来看，rRP更节省成本（增量成本效益比 = 332欧元/质量调整生命年）。在单向敏感性分析中，该模型对初始状态和复发状态成本的变化敏感。尽管由于使用放疗初始成本略高，但就质量调整生命年而言，机器人辅助立体定向体部放疗似乎比根治性前列腺切除术更具成本效益。在法国进行更长时间的比较生活质量研究将很有意思。
