Economic analysis of a phase III clinical trial evaluating the addition of total androgen suppression to radiation versus radiation alone for locally advanced prostate cancer (Radiation Therapy Oncology Group protocol 86-10).
OBJECTIVE
To evaluate the cost-effectiveness of adding hormone therapy to radiation for patients with locally advanced prostate cancer, using a Monte Carlo simulation of a Markov Model.


METHODS
Radiation Therapy Oncology Group (RTOG) protocol 86-10 randomized patients to receive radiation therapy (RT) alone or RT plus total androgen suppression (RTHormones) 2 months before and during RT for the treatment of locally advanced prostate cancer. A Markov model was designed with Data Pro (TreeAge Software, Williamstown, MA). The analysis took a payer's perspective. Transition probabilities from one state of health (i.e., with no disease progression or with hormone-responsive metastatic disease) to another were calculated from published rates pertaining to RTOG 86-10. Patients remained in one state of health for 1 year. Utility values for each health state and treatment were obtained from the literature. Distributions were sampled at random from the treatment utilities according to a second-order Monte Carlo simulation technique.


RESULTS
The mean expected cost for the RT-only treatments was 29,240 dollars (range, 29,138-29,403 dollars). The mean effectiveness for the RT-only treatment was 5.48 quality-adjusted life years (QALYs) (range, 5.47-5.50). The mean expected cost for RTHormones was 31,286 dollars (range, 31,058-31,555 dollars). The mean effectiveness was 6.43 QALYs (range, 6.42-6.44). Incremental cost-effectiveness analysis showed RTHormones to be within the range of cost-effectiveness at 2,153 dollars/QALY. Cost-effectiveness acceptability curve analysis resulted in a >80% probability that RTHormones is cost-effective.


CONCLUSIONS
Our analysis shows that adding hormonal treatment to RT improves health outcomes at a cost that is within the acceptable cost-effectiveness range.
Konski
Andre
A
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. a_konski@fccc.edu
Sherman
Eric
E
Krahn
Murray
M
Bremner
Karen
K
Beck
J Robert
JR
Watkins-Bruner
Deborah
D
Pilepich
Michael
M
D000726:Androgen Antagonists / Q000191:economics / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D008390:Markov Chains; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D011878:Radiotherapy / Q000191:economics
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen