Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France.
Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France.
Radiother Oncol. 2022 Aug;173:306-312. doi: 10.1016/j.radonc.2022.06.014. Epub 2022 Jun 27.
To evaluate the cost-effectiveness of moderate Hypofractionated Radiotherapy (H-RT) compared to Conventional Radiotherapy (C-RT) for intermediate-risk prostate caner (PCa).
A prospective randomized clinical trial including 222 patients from six French cancer centers was conducted as an ancillary study of the international PROstate Fractionated Irradiation Trial (PROFIT). We carried-out a cost-effectiveness analysis (CEA) from the payer's perspective, with a time horizon of 48 months. Patients assigned to the H-RT arm received 6000 cGy in 20 fractions over 4 weeks, or 7800 cGy in 39 fractions over 7 to 8 weeks in the C-RT arm. Patients completed quality of life (QoL) questionnaire: Expanded Prostate Cancer Index Composite (EPIC) at baseline, 24 and 48 months, which were mapped to obtain a EuroQol five-dimensional questionnaire (EQ-5D) equivalent to generate Quality Adjusted Life Years (QALY). We assessed differences in QALYs and costs between the two arms with Generalized Linear Models (GLMs). Costs, estimated in euro (€) 2020, were combined with QALYs to estimate the Incremental Cost-effectiveness ratio (ICER) with non-parametric bootstrap.
Total costs per patien were lower in the H-RT arm compared to the C-RT arm €3,062 (95 % CI: 2,368 to 3,754) versus €4,285 (95 % CI: 3,355 to 5,215), (p < 0.05). QALY were marginally higher in the H-RT arm, however this difference was not significant: 0.044 (95 % CI: - 0.016 to 0.099).
Treating localized prostate cancer with moderate H-RT could reduce national health insurance spending. Adopting such a treatment with an updated reimbursement tariff would result in improving resource allocation in RT management.
评估中危前列腺癌中度适形放疗（H-RT）与常规放疗（C-RT）相比的成本效益。
这是一项在法国六个癌症中心开展的前瞻性随机临床试验，是国际前列腺分次照射试验（PROFIT）的辅助研究。我们从支付者的角度进行了成本效益分析（CEA），时间范围为 48 个月。H-RT 组患者接受 6000cGy/20 次/4 周，C-RT 组患者接受 7800cGy/39 次/7-8 周。患者在基线、24 和 48 个月时完成生活质量（QoL）问卷：前列腺癌指数综合量表（EPIC），并对问卷进行映射以获得与欧洲五维健康量表（EQ-5D）等效的质量调整生命年（QALY）。我们使用广义线性模型（GLM）评估了两组之间 QALY 和成本的差异。成本按 2020 年欧元（€）估算，与 QALYs 相结合以非参数自举法估算增量成本效益比（ICER）。
与 C-RT 组相比，H-RT 组每位患者的总费用更低，为 €3062（95%CI：2368 至 3754）比 €4285（95%CI：3355 至 5215），（p<0.05）。H-RT 组的 QALY 略高，但差异无统计学意义：0.044（95%CI：-0.016 至 0.099）。
用中度 H-RT 治疗局限性前列腺癌可减少国家健康保险支出。采用这种治疗方法，并根据最新的报销费率进行补偿，将改善放射治疗管理中的资源配置。
