title: A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer.
abstract: OBJECTIVE
  The NADiA ProsVue is a prognostic system that measures prostate-specific antigen slope to identify men at lower risk of clinical recurrence of prostate cancer after radical prostatectomy. We developed a decision-modeling framework to evaluate its cost-effectiveness to guide the use of adjuvant radiotherapy (ART).
  
  
  METHODS
  We populated the model using patient-level data and external sources. Patients were classified as intermediate risk or high risk on the basis of Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) nomogram and then stratified by the ProsVue slope (≤2 pg/mL/mo; >2 pg/mL/mo) and receipt of ART. In sensitivity analyses, we varied the effect of the ProsVue slope on the use of ART and other model parameters.
  
  
  RESULTS
  The cost-effectiveness of the ProsVue-guided strategy varied widely because of small differences in quality-adjusted life-years (QALYs) at 10 years. In the intermediate-risk group, when the use of ART decreased from 20% (standard care) to 7.5% among patients with a ProsVue slope value of 2 pg/mL/mo or less, the incremental cost-effectiveness ratio was $25,160/QALY. In the high-risk group, the use of ART would have to decrease from 40% (standard care) to 11.5% among those with a ProsVue slope value of 2 pg/mL/mo or less to obtain a ratio of $50,000/QALY. The cost-effectiveness ratios were sensitive to varying benefits of salvage therapy, quality of life, and costs of ART and ProsVue testing.
  
  
  CONCLUSIONS
  The effect of the ProsVue system on costs will be dependent on the extent to which ART decreases among men identified as having a low risk of recurrence. Its effect on QALYs will remain conditional on uncertain clinical and quality-of-life benefits associated with ART.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: shelby.reed@duke.edu.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Suzanne Biehn
authors.initials: SB
authors.lastname: Stewart
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA; Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000191:economics / Q000532:radiotherapy* / Q000601:surgery; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant / Q000191:economics / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: cost-benefit analysis; prostate cancer; prostate-specific antigen