title: A decision support model for cost-effectiveness of radical prostatectomy in localized prostate cancer.
abstract: OBJECTIVE
  This study aimed to develop a probabilistic decision support model to calculate the lifetime incremental cost-effectiveness ratio (ICER) between radical prostatectomy and watchful waiting for different patient groups.
  
  
  METHODS
  A randomized trial (SPCG-4) provided most data for this study. Data on survival, costs and quality of life were inputs in a decision analysis, and a decision support model was developed. The model can generate cost-effectiveness information on subgroups of patients with different characteristics.
  
  
  RESULTS
  Age was the most important independent factor explaining cost-effectiveness. The cost-effectiveness value varied from 21,026 Swedish kronor (SEK) to 858,703 SEK for those aged 65 to 75 years, depending on Gleason scores and prostate-specific antigen (PSA) values. Information from the decision support model can support decision makers in judging whether or not radical prostatectomy (RP) should be used to treat a specific patient group.
  
  
  CONCLUSIONS
  The cost-effectiveness ratio for RP varies with age, Gleason scores, and PSA values. Assuming a threshold value of 200,000 SEK per quality-adjusted life-year (QALY) gained, for patients aged ≤70 years the treatment was always cost-effective, except at age 70, Gleason 0-4 and PSA ≤10. Using the same threshold value at age 75, Gleason 7-9 (regardless of PSA) and Gleason 5-6 (with PSA >20) were cost-effective. Hence, RP was not perceived to be cost-effective in men aged 75 years with low Gleason and low PSA. Higher threshold values for patients with clinically localized prostate cancer could be discussed.
authors: Department of Biomedical Engineering, Division of Medical Informatics, Linköping University Hospital, Linköping, Sweden. johan.lyth@liu.se
authors: Johan
authors: J
authors: Lyth
authors: Swen-Olof
authors: SO
authors: Andersson
authors: Ove
authors: O
authors: Andrén
authors: Jan-Erik
authors: JE
authors: Johansson
authors: Per
authors: P
authors: Carlsson
authors: Nosrat
authors: N
authors: Shahsavar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000191:economics* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden; D057832:Watchful Waiting