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 lowrisk 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. Cancer 2016;122:1085-96. V C 2016 American Cancer Society.KEYWORDS: costs, decision analysis, health economics, outcomes research, prostate cancer, quality-adjusted life-years (QALYs). INTRODUCTIONProstate cancer (PCa) is the most commonly diagnosed noncutaneous cancer and one of the leading causes of death from cancer in males in developed countries.1 The estimated incidences were 27% and 24%, respectively, in the United States and Canada in 2014.2,3 Although the incidence of PCa has increased over the years, death rates have declined due to early detection and novel treatment options.1-3 Moreover, novel treatments such as minimally invasive surgery, intensitymodulated radiotherapy (IMRT), medications for metastatic castration-resistant prostate cancer (mCRPC), and bonetargeted therapies adopted by health care systems have transformed the contemporary management of PCa. The objective of these treatments is the improvement of survival and/or quality of life. [4][5][6][7] The 5-year relative survival rate for PCa ranges from 96% to 100%.

US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses

“…Prostate biopsies and management of postprocedure complications accounted for 72% of the total cost. The economic burden of screening must be weighed against the potential cost savings of earlier diagnoses as studies have shown a direct correlation between treatment cost per patient and the risk group at time of diagnosis [ 22 23 ]. One way to assess the cost effectiveness of PSA screening is to assess the value added by various screening strategies.…”

Genetics and biology of prostate cancer

“…The clinical relevance of TAMs in prostate cancer progression has been evaluated in several studies (Craig et al 2008;Gannon et al 2009;Nonomura et al 2011;Fujii et al 2013;Gollapudi et al 2013;Lanciotti et al 2014) and is consistent with the protumorigenic effects of TAMs observed in other cancer types; some studies suggest a link between TAMs and disease recurrence (Gannon et al 2009;Nonomura et al 2011). Craig et al 2008;Gannon et al 2009;Nonomura et al 2011;Gollapudi et al 2013;Lanciotti et al 2014;Escamilla et al 2015;Gao et al 2017;Maolake et al 2017 Mouse: (Gleason 3 + 3) are typically managed by active surveillance, as large randomized clinical trials show no mortality differences between active surveillance and radical prostatectomy or radiotherapy (Iversen et al 1995;Wilt et al 2012;Bill-Axelson et al 2014;Hamdy et al 2016;Sanyal et al 2016;Wilt et al 2017). At the other end of the spectrum are high-risk cancers (Gleason ≥8), which receive more aggressive treatment, including surgery and radiation-based therapies.…”

Novel therapeutic targets for cancer metastasis

“…For example, the current standard diagnostic test for prostate cancer that measures prostate specific antigen (PSA) levels in patient blood samples, has low specificity for early detection of prostate cancer, resulting in the overdiagnosis and overtreatment of men for this cancer [98]. However, newly developed tests that use patient-specific genetic data for early diagnosis and accurate stratification of low-risk/indolent versus high-risk/metastatic prostate cancer have led to better patient outcomes and high cure rates in clinical trials [99][100][101]. Use of these genetic data-based tests in clinical practice will represent personalized medical treatment of prostate cancer.…”