Accession Number:

ADA566502

Title:

Decision Analysis of the Benefits and Costs of Screening for Prostate Cancer

Descriptive Note:

Annual summary 27 Jul 2011-26 Jul 2012

Corporate Author:

DANA-FARBER CANCER INST BOSTON MA

Personal Author(s):

• Hayes, Julia H.

Report Date:

2012-08-01

Pagination or Media Count:

13.0

Abstract:

Observation has emerged as a strategy to avoid overtreatment in men with screen-detected low-risk prostate cancer CaP. This analysis examines the cost-effectiveness of observation with watchful waiting WW or active surveillance AS, radical prostatectomy RP, radiation therapy IMRT, and brachytherapy BT in these men. METHODS A Markov Monte Carlo model was constructed adverse effects AE of treatment were included. Main outcomes were costs 2008US, quality-adjusted life-years QALYs, and incremental cost-effectiveness ratios ICERs for men 65, 55, and 75 years of age. RESULTS In 65 year old men, AS was associated with the greatest QALE but at 35,201 was more expensive than brachytherapyICER 15,420QALY RP and IMRT were dominated. In 55 and 75 year old men these ICERs were 8,374QALY and 8,671QALY, respectively. When costs of treatment of adverse effects were doubled, AS became least expensive in all men. When the PIVOT trial was simulated, WW was cost-saving compared with AS and RP and remained less expensive and associated with improved QALE over a wide range of cost and utilities, including if the risk of CaP-specific death on AS was 50 the risk on WW. CONCLUSIONS In this model, observation is a cost-effective alternative to initial treatment and is underutilized in these men.

Descriptors:

• *CANCER SCREENING
• *COST EFFECTIVENESS
• *PROSTATE CANCER
• DECISION THEORY
• MONTE CARLO METHOD
• RADIOTHERAPY

Subject Categories:

• Economics and Cost Analysis
• Anatomy and Physiology
• Medicine and Medical Research

Distribution Statement:

APPROVED FOR PUBLIC RELEASE