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A Trial-Based Cost-Utility Analysis of Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer
Elise De Bleser1,2, Ruben Willems3, Karel Decaestecker1,2
1Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium.
Abstract:
The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population. The objective was to assess cost-utility from a Belgian healthcare payer's perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT. A Markov decision-analytic trial-based model was developed, projecting the results over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature. Treatment costs were derived from official government documents. Probabilistic sensitivity analyses showed that MDT is cost-effective compared to surveillance (ICER: €8393/quality adjusted life year (QALY)) and immediate ADT (dominant strategy). The ICER is most sensitive to utilities in the different health states and the first month MDT cost. At a willingness-to-pay threshold of €40,000 per QALY, the cost of the first month MDT should not exceed €8136 to be cost-effective compared to surveillance. The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison with immediate ADT.
Insights
Metastasis-directed therapy (MDT) for oligorecurrent prostate cancer (PCa) is cost-effective compared to surveillance and immediate androgen deprivation therapy (ADT). MDT offers a potentially valuable treatment strategy for managing oligorecurrent PCa.
Area of Science:
- Oncology
- Health Economics
- Urology
Background:
- Optimal management for oligorecurrent prostate cancer (PCa) remains unclear.
- Metastasis-directed therapy (MDT) is gaining attention for PCa patients with limited metastatic sites.
- Current treatment options include surveillance, immediate androgen deprivation therapy (ADT), and delayed ADT.
Purpose of the Study:
- To evaluate the cost-utility of MDT plus delayed ADT versus surveillance plus delayed ADT and immediate ADT.
- To assess these strategies from a Belgian healthcare payer's perspective.
- To inform clinical decision-making for oligorecurrent PCa.
Main Methods:
- A Markov decision-analytic model was employed over a 5-year horizon.
- Clinical data were sourced from the STOMP trial and existing literature.
- Treatment costs were obtained from official Belgian government documents.
Main Results:
- MDT was found to be cost-effective compared to surveillance, with an incremental cost-effectiveness ratio (ICER) of €8393/QALY.
- MDT was the dominant strategy compared to immediate ADT.
- Sensitivity analyses indicated that utilities and initial MDT costs significantly impact the ICER.
Conclusions:
- MDT for oligorecurrent prostate cancer presents a potentially cost-effective strategy.
- This approach is favorable when compared to both surveillance with delayed ADT and immediate ADT.
- The findings support the consideration of MDT in the management of oligorecurrent PCa within the Belgian healthcare system.
