Comparative cost-effectiveness of focal and total salvage 125 I brachytherapy for recurrent prostate cancer after primary radiotherapy

Abstract

PurposeFocal salvage (FS) iodine 125 (125I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS.Material and methodsA decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY.ResultsFocal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity.ConclusionsFocal salvage 125I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity.

Clinical efficacy and prognostic factors of CT-guided 125I brachytherapy for the palliative treatment of retroperitoneal metastatic lymph nodes

“…Previous studies don't further explore the factors that can affect clinical efficacy and survival of 125 I brachytherapy [15][16][17][18][19]. Therefore, the main purpose of our study was to explore the potential factors that could influence the clinical efficacy of 125 I brachytherapy.…”

“…One of the advantages of brachytherapy is that radiation exposure is localized, thereby preventing off-target radiation damage to adjacent normal tissues [15]. As a result, brachytherapy is often used in patients with tumors in complex locations, or in patients who cannot tolerate traditional radiotherapy [16][17][18]. Due to their complex anatomical location, retroperitoneal metastatic lymph nodes are more suitable for this minimally invasive and safe 125 I brachytherapy.…”

Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

“…Death from cancer can only occur after a patient has been transitioned to biochemical progression. [29]. We assumed that patients with biochemical progression received hormonal therapy only.…”

Radiation treatment of prostate cancers – the contemporary role of modern brachytherapy techniques

“…Salvage therapy is another indication for prostate brachytherapy, using LDR or HDR, with promising results in terms of efficiency and relative low cost when compared to other techniques [ 17 , 18 ].…”