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Table 3 Health utilities weights and decrements in the model

From: Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore

Parameter Value (range) Source Other remarks
Cancer health state
No cancer 0.85 (0.83 to 0.86) Clemens et al. 2014
Low-risk localized prostate cancer 0.84 (0.836 to 0.844) Stewart et al. 2005 At baseline, the utility value for patients at the metastasis state is 0.67. The utility is reduced to 0.4 when they progress to castration-resistant prostate cancer. In the last two months before death, metastatic patients’ utility was assumed to increase to 0.67 as they would receive palliative care to maintain quality of life.
Intermediate-risk localized prostate cancer 0.81 (0.803 to 0.817)
High-risk localized prostate cancer 0.71 (0.701 to 0.719)
Metastasis 0.67 (0.660 to 0.680)
Utility benefit of active treatment 0.01 Korfage et al. 2005 Utility benefit was derived from the difference before and after the active treatment in Korfage et al. (2005). Utility values at the active treatment health state: 0.85 for low-risk prostate cancer; 0.82 for intermediate-risk; 0.72 for high-risk.
Castration-resistant prostate cancer 0.40 (0.3 to 0.5) Bayoumi et al. 2000
Utilities decrement
Age 0.0002587 + 0.0000332* (age^2-(age-1)^2) Ara and Brazier 2010
Biopsy complication – saturation biopsy 0.00677 (0.00577 to 0.00769) Brown et al. 2018 Utility change post-saturation biopsy of −0.176 (−0.15 to −0.2) was obtained from PROMIS individual patient data: 0.176*2/52 = 0.00677; Utility change post-systematic biopsy: 0.101*2/52 = 0.00388.
Biopsy complication – systematic biopsy 0.00388 (0.00349 to 0.00427) NICE (2019)
Treatment complication – erectile dysfunction 0.1 Krahn et al. 2003 Erectile dysfunction and urinary urgency are lifelong complications.
Treatment complication – urinary urgency 0.06
Treatment complication – bowel problem 0.11
Recurrence 0.0206 (0 to 0.08893) Ramsay et al. 2012 Utility value for chemical recurrence reported in Ramsay et al. (2012) is 0.73 for patients with high-risk prostate cancer, based on a baseline utility for men without cancer of 0.95, which was higher than that used in our model (0.85). Utility decrement associated with chemical recurrence applied in the model was therefore calculated by deducting the baseline utility of high-risk prostate cancer by the adjusted value for chemical recurrence: 0.71–0.73*(0.85/0.9) = 0.0206.
  1. Notes
  2. 1. The uncertainty of model inputs was explored by simultaneously and randomly sampling the parameters from assigned distributions – beta distribution for health utilities values and multivariate normal distributions using Cholesky decomposition matrix for parameters characterizing disease progression.