Authors (Year) Country [Reference] | Mean Cost Mean Incremental (Δ) Cost | Effectiveness measure or Incremental (Δ) QALYs | ICER | Sensitivity Analyses | Conclusions |
---|---|---|---|---|---|
A. Expectant management (active survaillance or watchful waiting) vs other treatments | |||||
Koerber, et al. (2014) [28] | Mean Cost: RP €16468; AS €9585 Mean Δ Cost RP vs AS: €6883 | Life expectancy: RP 12.15; AS 12.07 QALYs: RP 7.56; AS 7.60 | €/Life year gained for RP: 96420 €/QALY gained: AS resulted a dominant strategy over RP. | -Probability of metastases in AS -AS utility weights -Time horizon: 5, 15 and 30 years. -Discount rate 0,5,7 and 10 % | “AS is likely to be a cost-saving treatment strategy for some patients with early stage localized prostate cancer. However, cost-effectiveness is dependent on patients’ valuation of health states […]” |
Lyth, et al. (2012) [29] | Mean Δ Cost RP vs WW: S1-SEK 40116 S2-SEK 49784 S3-SEK 59160 S4-SEK 63834 S5-SEK 70074 S6-SEK 72439 | Δ QALY: S1-0.57 S2-0.86 S3-0.25 S4-0.42 S5-0.08 S6-0.15 | SEK/QALY gained for RP: S1-70766 S2-58045 S3-232409 S4-150274 S5-858703 S6-472327 | Scenarios: S1-65y Gleason 0–4 S2-65y Gleason 5–6 S3-70y Gleason 0–4 S4-70y Gleason 5–6 S5-75y Gleason 0–4 S6-75y Gleason 5–6 | “Assuming a threshold value of 200000 SEK/QALY gained, for patients aged ≤70 years the treatment is always cost-effective, except at age 70, Gleason 0–4 and PSA ≤10 […]” |
Andersson, et al. (2011) [30] | Mean Cost: RP €24247; WW €18124 | Not Applicable | Not Applicable | Not Applicable | “In this economic evaluation of RP versus WW of localized prostate cancer in a randomized study, RP was associated with 34 % higher costs. […]” |
Bauvin, et al. (2003) [31] | Mean Cost: RP €8533; WW €2143 | 5 year survival: RP 89 %; WW 78 % 5 year relative survival: RP 97 %; WW 95 % | ICER not reported | Not reported | Results supported the cost-effectiveness of radical prostatectomy over watchful waiting. |
Hummel, et al. (2003) [22] | Mean Cost: WW £1714 BT £6880 3DCRT £2103 | QALYs: WW 8.88 BT 9.28 3DCRT 8.89 | £/QALY gained (WW as reference): -12828 for BT -26766 for 3DCRT | -Incidence of adverse events -Utilities -Age -Costs | “[…] It is difficult therefore to draw conclusions on the relative benefits or otherwise of the newer technologies owing to the lack of substantive evidence of any quality and the lack of comparisons between the newer technologies and with standard treatments. […]” |
B. Robot-assisted laparoscopic prostatectomy (RALP) vs other surgical techniques | |||||
Lord, et al. (2013) [32] | Mean Costs: RRP £6485; LRP £6534 PRP £6510; RALP £6458 | QALYs: RRP 7.937; LRP 7.936 PRP 7.936; RALRP 7.943 | £/QALY gained: RALP resulted a dominant strategy over all other | -Willingness-to-pay threshold | “[…] The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new Clinical Guidelines.” |
Close, et al. (2013) [33] | Mean Costs: RALP £9040; LRP £7628 N° Procedures/year (P/year) 200 RALP £9040; LRP £7628 150 RALP £9799; LRP £7628 100 RALP £11312; LRP £7628 50 RALP £15859; LRP£7628 Three-arm robot (Da Vinci®) with 200 P/year: RALP £8168; LRP £7628 | QALYs: RALP 6.52; RLP 6.44 | £/QALY gained for RALP: -18329 for 200 P/year -28172 for 150 P/year -47822 for 100 P/year -106839 for 50 P/year Three-arm robot (DaVinci®)) £7009/QALY for 200 P/year | -Positive margin rate after RALP -Procedures/year -Patient’s lifetime -Price of robotic system | “Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.” |
Barbaro, et al. (2012) [34] | Mean Surgical Costs: RALP €20103; RRP €2764 Mean Hospital Costs: RALP €3358; RRP €2791 Mean Total Costs: RALP €23610; RRP €5635 | Not Applicable | Not Applicable | -Case volumes -Operating times | ” In the current circumstances, increasing the use of RAP at the San Giovanni Battista Hospital does not appear expedient. This conclusion is corroborated by the sensitivity analysis which showed that RAP carries higher costs than RRP.” |
Hohwu, et al. (2011) [35] | Mean direct costs: RALP €8369 RRP €3863 Mean Indirect costs: RALP €13411 RRP €12465 | Successful treatment: RALP 34 %; RRP 27 % Δ QALYs: RALP 0.0103; RRP 0.0116 | €/extra successful treatment for RALP -64343 for direct costs -13514 for indirect costs €/QALY gained for RALP: Not applicable because no QALY gained | -Life time for robot -Procedures/year | “RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot” |
C. Conventional external radiotherapy vs new modalities | |||||
Hummel, et al. (2012) [36] | Mean total discounted costs: IMRT/3DCRT S1-£6173/£5184 S2-£4946/£4214 S3-£4946/£4486 S4-£5687/£7489 | Total discounted QALY: IMRT/3DCRT S1-6.802/6.792 S2-7.070/7.046 S3-7.070/6.983 S4-7.015/6.402 | £/QALY gained for IMRT: S1-104066 S2-31162 S3-5295 S4-dominant strategy. | Scenarios: S1-equal dose& PSA relapse S2-15 % difference in late gastro intestinal toxicity S3-3.8 y survival difference S4-6.6 y survival difference | “If IMRT can be used to prolong survival, it is very cost-effective. Otherwise cost-effectiveness is uncertain” |
Lundkvist, et al. (2005) [37] | Δ total cost for standard case Proton Therapy vs External Radiotherapy: €7953 per patient, | Δ QALY for Proton Therapy: 0.297/patient | €/QALY gained for Proton Therapy:–26776 | Not reported | “Proton therapy was cost-effective if appropriate risk groups were chosen. The results must be interpreted with caution, since there is a lack of data, and consequently large uncertainties in the assumptions used” |
Hummel, et al. (2003) [22] | Mean total costs: 2DRT £1886 BT £6880 3DCRT £2103 | QALYs: 2DRT 8.56 BT 9.28 3DCRT 8.89 | £/QALY gained (2DRT as reference): -8575 for BT -683 for 3DCRT | -Incidence of adverse events -Utilities -Age -Costs | See above |
D. Prostatectomy vs radiation treatment | |||||
Becerra, et al. (2011) [38] | Mean total cost: RP €6863.70 BT €5453.60 3DCRT €3336.10 | Not Applicable | Not Applicable | -Cost of 3DCRT | “Radical prostatectomy therapeutic proved to be the most expensive treatment option. […] Most of the costs were explained by the therapeutic option, and neither comorbidity nor risk groups showed an effect of total costs independent of treatment.” |
Buron, et al. (2007) [39] | Mean societal cost: BT €8019; RP €8715 Mean Initial treatment costs: BT €7159; RP €6472 Mean hospital follow-up costs: BT €268; RP €992 Mean Outpatient costs: BT €482; RP €419 Mean loss productivity costs: BT €620; RP €3678 | Urinary incontinence BT 20 %; RP 49 % Fecal incontinence BT 9 %; RP 2 % Rectal Bleeding BT 15 %; RP 0 % Erectile Dysfunction BT 45.8 %; RP 83.3 % | ICER not reported | Not reported | “This study suggests a similar cost profile in France for BT and RP but with different health-related quality of life and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients’ needs.” |
Hummel, et al. (2003) [22] | Mean total costs: RP £6359 BT £6880 3DCRT £2103 | QALYs RP 8.93 BT 9.28 3DCRT 8.89 | £/QALY gained (RP as reference): -12828 for BT -Not Applicable | - Incidence of adverse events -Utilities -Age -Costs | See above |