title: Estimating preferences for treatments in patients with localized prostate cancer.
abstract: OBJECTIVE
  Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects.
  
  
  METHODS
  This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias.
  
  
  RESULTS
  Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects.
  
  
  CONCLUSIONS
  Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ávila
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Becerra
authors.affiliation: Servicio de Oncología Radioterápica, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Guedea
authors.affiliation: Servicio de Urología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Suárez
authors.affiliation: Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernandez
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Macías
authors.affiliation: Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mariño
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Hervás
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Herruzo
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Ortiz
authors.affiliation: Servicio de Urología, Fundació Puigvert, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ponce de León
authors.affiliation: Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Sancho
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Cunillera
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Pardo
authors.affiliation: Epidemiology and Evaluation Research Group, Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.affiliation: Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain. Electronic address: mferrer@imim.es.
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D003661:Decision Support Techniques; D005716:Game Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D011468:Prostatectomy / Q000191:economics* / Q000523:psychology; D011471:Prostatic Neoplasms / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D011832:Radiation Injuries / Q000191:economics* / Q000517:prevention & control; D011878:Radiotherapy / Q000191:economics* / Q000523:psychology; D018570:Risk Assessment / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013030:Spain