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Table 2 Main findings of economic evaluations identified in the systematic review

From: Economic evaluation of treatments for patients with localized prostate cancer in Europe: a systematic review

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

  1. Abbreviations: AS Active Surveillance, BT Brachytherapy, ICER Incremental Cost-Effectiveness Ratio, IMRT Intensity-Modulated Radiation Therapy, LRP Laparoscopic Prostatectomy, RALP Robot-Assisted Laparoscopic Prostatectomy, RP Radical Prostatectomy, PRP Perineal Radical Prostatectomy, RRP Radical Retropubic Prostatectomy, QALYs Quality-Adjusted Life Years, WW Watchful Waiting, 2DRT Two Dimensional Radiotherapy, 3DCRT Three Dimensional Conformal Radiotherapy