Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer.
OBJECTIVE
To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC).


METHODS
Cost-utility analysis using decision analytic modelling by a Markov model.


METHODS
Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10,000 iteration Monte Carlo simulation.


RESULTS
SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29,719 (€37,619) (95% CI -51,985 to -9243). For a ceiling ratio of £30,000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty.


CONCLUSIONS
The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs.


BACKGROUND
This economic analysis was undertaken as part of the CROP RCT study
72677390; it was a pre-trial economic model developed and analysed during the pre-results stage of the RCT.
Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Kathleen A
KA
Boyd
Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden, Glasgow, UK.
Rob J
RJ
Jones
Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK.
Jim
J
Paul
Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK.
Fiona
F
Birrell
Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Andrew H
AH
Briggs
Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden, Glasgow, UK Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK Beatson Institute for Cancer Research, Bearsden, Glasgow, UK.
Hing Y
HY
Leung
D000368:Aged; D003362:Cost-Benefit Analysis; D017679:Cryotherapy / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016879:Salvage Therapy / Q000191:economics*
Prostate disease < UROLOGY; androgen deprivation therapy; cost-effectiveness analysis; radiation recurrent prostate cancer