Fridhammar Adam, Frisell Oskar, Wahlberg Karin, Berglund Emelie, Röbeck Pontus, Persson Sofie
The Swedish Institute for Health Economics, Lund, Sweden.
Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
Pharmacoeconomics. 2025 May;43(5):509-520. doi: 10.1007/s40273-024-01466-9. Epub 2025 Jan 11.
The Prostatype score (P-score) is a prognostic biomarker that integrates a three-gene (IGFBP3, F3, and VGLL3) signature derived from prostate biopsy samples, with key clinical parameters, including prostate-specific antigen (PSA) levels, Gleason grade, and tumor stage at diagnosis. The test has demonstrated superior predictive accuracy for prostate cancer outcomes compared with traditional risk categorization systems such as D'Amico. Notably, it reclassifies a higher proportion of patients into the low-risk category, making them eligible for active surveillance. This study assessed the cost-effectiveness of the P-score in comparison with D'Amico and the Swedish National Prostate Cancer Register (NPCR) risk categorization systems.
A two-step decision analytic model was developed. The model consisted of a decision tree-informed Markov structure estimating the lifetime outcomes of 60-year-old men with diagnosed prostate cancer. Prostate cancer was classified as low-risk, intermediate-risk, or high-risk using either the P-score or D'Amico. Initial therapy was based on observed treatment patterns from the Swedish NPCR. Costs (SEK, year 2022) and quality-adjusted life years (QALYs) were estimated from a healthcare perspective and discounted at 3% per year; incremental cost-effectiveness ratio (ICER) was the primary outcome.
The P-score led to cost savings and generated an additional 0.19 QALYs compared with D'Amico. The added costs of the genetic test and higher costs of active surveillance and radiotherapy were counterbalanced by savings from reduced costs of surgery, treatment-related side-effects, and metastatic disease. The gain in QALYs was primarily due to the avoidance of metastatic disease and a reduction in treatment-related side-effects.
The results of this study suggest that the P-score is likely to be a cost-effective alternative to D'Amico for prognostic evaluation of newly diagnosed prostate cancer in Sweden and compared with NPCR when health-related quality of life was included.
前列腺分型评分（P 评分）是一种预后生物标志物，它整合了源自前列腺活检样本的三基因（胰岛素样生长因子结合蛋白 3、组织因子和 VGLL3）特征以及关键临床参数，包括前列腺特异性抗原（PSA）水平、 Gleason 分级和诊断时的肿瘤分期。与传统风险分类系统（如达米科系统）相比，该检测在预测前列腺癌预后方面显示出更高的准确性。值得注意的是，它将更高比例的患者重新分类为低风险类别，使他们有资格接受主动监测。本研究评估了 P 评分与达米科系统和瑞典国家前列腺癌登记处（NPCR）风险分类系统相比的成本效益。
开发了一个两步决策分析模型。该模型由一个基于决策树的马尔可夫结构组成，用于估计 60 岁前列腺癌确诊男性的终生预后。使用 P 评分或达米科系统将前列腺癌分为低风险、中风险或高风险。初始治疗基于瑞典 NPCR 观察到的治疗模式。从医疗保健角度估计成本（瑞典克朗，2022 年）和质量调整生命年（QALY），并按每年 3%进行贴现；增量成本效益比（ICER）是主要结果。
与达米科系统相比，P 评分节省了成本，并额外产生了 0.19 个 QALY。基因检测的额外成本以及主动监测和放疗的更高成本被手术成本降低、治疗相关副作用和转移性疾病成本降低所抵消。QALY 的增加主要是由于避免了转移性疾病和治疗相关副作用的减少。
本研究结果表明，在瑞典对新诊断的前列腺癌进行预后评估时，P 评分可能是达米科系统具有成本效益的替代方案，并且在纳入与健康相关的生活质量时，与 NPCR 相比也是如此。
Zotero 插件