Focal therapy treats individual areas of tumour in non-metastatic prostate cancer in patients unsuitable for active surveillance. The aim of this work was to evaluate the cost-effectiveness of focal therapy versus prostatectomy and external beam radiotherapy (EBRT).
A Markov cohort health state transition model with four health states (stable disease, local recurrence, metastatic disease and death) was created, evaluating costs and utilities over a 10-year time horizon for patients diagnosed with non-metastatic prostate cancer. National Health Service (NHS) for England perspective was used, based on direct healthcare costs. Clinical transition probabilities were derived from prostate cancer registries in patients undergoing radical prostatectomy, EBRT and focal therapy using cryotherapy (Boston Scientific) or high-intensity focused ultrasound (HIFU) (Sonablate). Propensity score matching was used to ensure at-risk populations were comparable. Variables included age, prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group, maximum cancer core length (mm), T-stage and year of treatment.
Focal therapy was associated with a lower overall cost and higher quality adjusted life year (QALY) gains than either prostatectomy or EBRT, dominating both treatment strategies. Positive incremental net monetary benefit (NMB) values confirm focal therapy as cost effective versus the alternatives at a willingness to pay (WTP) threshold of £30,000/QALY. One-way deterministic sensitivity analyses revealed consistent results.
Data used to calculate the transition probabilities were derived from a limited number of hospitals meaning that other potential treatment options were excluded. Limited data were available on later outcomes and none on quality of life data, therefore, literature-based estimates were used.
Cost-effectiveness modelling demonstrates use of focal therapy (cryotherapy or HIFU) is associated with greater QALY gains at a lower overall cost than either radical prostatectomy or EBRT, representing good value for money in the NHS.
Focal therapy can be used for the primary treatment of individual areas of cancer in those patients with prostate cancer whose disease has not spread (localized or non-metastatic prostate cancer) that are not suitable for active monitoring of their disease. Focal therapy in these patients results in similar control of the cancer to more invasive therapies, such as surgical removal of the prostate and radiotherapy, with the benefit of fewer sexual, urinary and rectal side effects. This work considered whether using focal therapy (either freezing the cancer cells using cryotherapy or using high-intensity focused ultrasound [HIFU] to destroy cancer cells) was good value for money in the National Health Service (NHS) compared with surgery or radiotherapy. An economic model was developed which considered the relative impact of treatment with focal therapies, surgery or radiotherapy within the NHS in England. Previously collected information from people undergoing treatment for their prostate cancer, together with published literature and clinical opinion, was used within the model to predict the treatment pathway, costs incurred and the results of treatment in terms of patient benefits (effectiveness and quality of life). The model showed that focal therapy using either cryotherapy or HIFU was associated with a lower overall cost and higher patient benefit than either surgery or radiotherapy, indicating that focal therapy represents good value for money in the NHS.
Journal of medical economics. 2023 Sep 01 [Epub ahead of print]
Deepika Reddy, Marieke van Son, Max Peters, Mariana Bertoncelli Tanaka, Tim Dudderidge, Emma Cullen, Carmen Lok Tung Ho, Richard G Hindley, Amr Emara, Stuart McCracken, Clement Orczyk, Iqbal Shergill, Stephen Mangar, Raj Nigam, Jaspal Virdi, Caroline M Moore, Manit Arya, Taimur T Shah, Mathias Winkler, Mark Emberton, Alison Falconer, Jonathan Belsey, Hashim U Ahmed
Imperial College, London, UK., Amsterdam University Medical Centers, The Netherlands., Imperial College NHS Healthcare Trust, London, UK., University Hospital Southampton NHS Trust, Southampton, UK., Hampshire Hospitals NHS Foundation Trust, UK., Sunderland Royal Hospital, Sunderland, UK., University College London NHS Foundation Trust, London, UK., Wrexham Maelor Hospital, Wrexham, UK., Royal Surrey NHS Foundation Trust, Guildford, UK., Princess Alexandra Hospital NHS Trust, Harlow, UK., JB Medical Limited, Sudbury, UK.