Long-term hormone therapy and radiation is cost-effective for patients with locally advanced prostate carcinoma.
BACKGROUND
In Radiation Therapy Oncology Group (RTOG) trial 92-02, after men received neoadjuvant hormone cytoreduction and radiotherapy for locally advanced prostate carcinoma, they were randomized to receive either 2 years of long-term androgen-deprivation (LTAD) or no further treatment (short-term androgen-deprivation [STAD]). The specific objective of the current study was to determine whether LTAD was a cost-effective treatment for patients with locally advanced prostate carcinoma.


METHODS
The cost-effectiveness of LTAD was tested using a Markov model that was designed using proprietary software. The analysis took a payor's perspective. Unit costs were obtained by estimation using a global Medicare fee schedule. Costs and outcomes were discounted by 3%. Distributions were sampled at random from the treatment utilities, transition probabilities, and costs using a second-order Monte Carlo simulation technique.


RESULTS
The expected mean cost was 32,564 dollars for LTAD compared with 33,039 dollars for STAD after accounting for the additional cost of salvage treatment for men who were treated with STAD. The mean number of quality-adjusted life years (QALYs) for men who received LTAD was 4.13 QALYs compared with a mean of 3.68 QALYs for men who received STAD. The cost-effectiveness acceptability curve analysis showed a 91% probability that LTAD was cost-effective compared with STAD. Although overall survival was similar in the LTAD and STAD groups, the patients who received LTAD experienced gains in QALYs and had lower costs, because LTAD prevented biochemical failure and the necessitating salvage hormone therapy.


CONCLUSIONS
The current analysis showed that LTAD was cost-effective for the entire population studied in RTOG trial 92-02.
Konski
Andre
A
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA. andre.konski@fccc.edu
Watkins-Bruner
Deborah
D
Brereton
Harmar
H
Feigenberg
Steven
S
Hanks
Gerald
G
D000230:Adenocarcinoma / Q000188:drug therapy / Q000191:economics* / Q000532:radiotherapy; D000726:Androgen Antagonists / Q000191:economics / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005485:Flutamide / Q000191:economics / Q000627:therapeutic use; D017273:Goserelin / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D020360:Neoadjuvant Therapy / Q000191:economics; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000532:radiotherapy; D019057:Quality-Adjusted Life Years; D020266:Radiotherapy, Conformal / Q000191:economics; D016032:Randomized Controlled Trials as Topic
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D005485:Flutamide