He Jiaoxue, Wang Qingfeng, Hu Qiancheng, Li Changlin
Department of Clinical Medicine, Southwest Medical University, Luzhou Sichuan, China.
Department of Oncology, Wenjiang District People's Hospital, Wenjiang, Chengdu, China.
Front Oncol. 2023 Jan 13;12:841356. doi: 10.3389/fonc.2022.841356. eCollection 2022.
Radiotherapy is an effective curative treatment option for intermediate- to high-risk localized prostate cancer. According to the HYPO-RT-PC trial (ISRCTN45905321), there was no significant difference in 5 years of follow-up in terms of failure-free survival, overall survival, urinary toxicity, and bowel toxicity, while erectile function decreased between ultra-hypofractionated radiotherapy with conventionally fractionated radiotherapy, except that the incidence of urinary toxicity in ultra-hypofractionated radiotherapy was higher at 1 year of follow-up. We evaluated the cost-effectiveness of ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate- to high-risk localized prostate cancer from the Chinese payer's perspective.
We developed a Markov model with a 15-year time horizon to compare the cost and effectiveness of ultra-hypofractionated radiotherapy with those of conventionally fractionated radiotherapy for localized intermediate- to high-risk prostate cancer. The outcomes were measured in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and willingness-to-pay (WTP). Univariable and probability sensitivity analyses were performed to evaluate the robustness of the Markov model.
Based on the Markov model, conventionally fractionated radiotherapy yielded 2.32 QALYs compared with 2.14 QALYs in ultra-hypofractionated radiotherapy in China. The cost of ultra-hypofractionated radiotherapy was found to be decreased by about 14% folds ($4,251.04) in comparison with that of conventionally fractionated radiotherapy. The ICER of conventionally fractionated radiotherapy that of ultra-hypofractionated radiotherapy was $23,616.89 per QALY in China. The failure-free survival with grade 2 or worse urinary toxicity and the discount rate per annum were the most sensitive parameters utilized in ultra-hypofractionated radiotherapy. The cost-effectiveness acceptability curve showed that conventionally fractionated radiotherapy had 57.7% probability of being cost-effective under the Chinese WTP threshold.
From the perspective of Chinese payers, ultra-hypofractionated radiotherapy was not a cost-effective strategy compared with conventionally fractionated radiotherapy for patients with localized intermediate- to high-risk prostate cancer. Nevertheless, reduction of the grade 2 or worse urinary toxicity of ultra-hypofractionated radiotherapy could alter the results.
放射治疗是中高危局限性前列腺癌的一种有效治愈性治疗选择。根据HYPO-RT-PC试验（ISRCTN45905321），在无失败生存期、总生存期、泌尿毒性和肠道毒性方面，5年随访期内无显著差异，而与常规分割放疗相比，超分割放疗后勃起功能有所下降，不过超分割放疗在随访1年时泌尿毒性发生率更高。我们从中国支付方的角度评估了超分割放疗和常规分割放疗用于中高危局限性前列腺癌的成本效益。
我们构建了一个15年时间范围的马尔可夫模型，以比较超分割放疗与常规分割放疗用于局限性中高危前列腺癌的成本和效果。结果通过质量调整生命年（QALY）、增量成本效益比（ICER）和支付意愿（WTP）来衡量。进行单变量和概率敏感性分析以评估马尔可夫模型的稳健性。
基于马尔可夫模型，在中国，常规分割放疗产生2.32个QALY，而超分割放疗产生2.14个QALY。与常规分割放疗相比，超分割放疗的成本降低了约14倍（4251.04美元）。在中国，常规分割放疗相对于超分割放疗的ICER为每QALY 23616.89美元。超分割放疗中最敏感的参数是2级或更严重泌尿毒性的无失败生存期和每年的贴现率。成本效益可接受性曲线显示，在中国支付意愿阈值下，常规分割放疗具有成本效益的概率为57.7%。
从中国支付方的角度来看，对于局限性中高危前列腺癌患者，与常规分割放疗相比，超分割放疗不是一种具有成本效益的策略。然而，降低超分割放疗2级或更严重的泌尿毒性可能会改变结果。
