title: Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality-adjusted life-year analysis.
abstract: BACKGROUND
  To the authors' knowledge, the literature to date lacks studies examining lifetime costs and quality-adjusted life-years (QALYs) of prostate cancer (PCa) management strategies that integrate localized and advanced disease. The objective of the current study was to assess lifetime costs and QALYs associated with contemporary PCa management strategies across risk groups by integrating localized and advanced disease.
  
  
  METHODS
  The authors' validated Markov chain Monte Carlo model was used to predict lifetime direct costs and QALYs. The health states modeled were active surveillance, initial treatments (radical prostatectomy or radiotherapy), PCa recurrence, PCa recurrence free, metastatic castration-resistant prostate cancer, and death (cause specific/other causes). Data regarding treatment distribution, state transition probabilities, adverse effects of management options, costs, utilities, and disutilities were derived from the published literature.
  
  
  RESULTS
  The total cost per patient for the overall cohort increased from $18,503 at 5 years to $28,032 and $39,143, respectively, at 10 years and 15 years. Furthermore, the results indicated the influence of risk group on total cost, with the high-risk group accruing the maximum per patient cost followed by the intermediate-risk and low-risk groups. Active surveillance was found to confer the most QALYs (12.5 years) and was the least costly strategy ($18,452) for individuals at low risk. For all risk groups, radical prostatectomy was less costly and conferred modestly more QALYs compared with intensity-modulated radiotherapy modalities.
  
  
  CONCLUSIONS
  Public health care systems in Canada and elsewhere are operating under budget constraints to allocate finite resources. The findings of the current study might inform discussions concerning budget planning to provide health care services.
authors.affiliation: Department of Urology, McGill University, Montreal, Quebec, Canada.
authors.forename: Chiranjeev
authors.initials: C
authors.lastname: Sanyal
authors.affiliation: Department of Urology, McGill University, Montreal, Quebec, Canada.|Research Institute of McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.affiliation: Department of Urology, McGill University, Montreal, Quebec, Canada.|Division of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Fabio L
authors.initials: FL
authors.lastname: Cury
authors.affiliation: Department of Urology, McGill University, Montreal, Quebec, Canada.|Research Institute of McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Simone
authors.initials: S
authors.lastname: Chevalier
authors.affiliation: Department of Urology, McGill University, Montreal, Quebec, Canada.|Research Institute of McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Dragomir
mesh_terms: D002170:Canada; D015331:Cohort Studies; D017281:Cost of Illness; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D011471:Prostatic Neoplasms / Q000191:economics* / Q000628:therapy; D019057:Quality-Adjusted Life Years
keywords: costs; decision analysis; health economics; outcomes research; prostate cancer; quality-adjusted life-years (QALYs)