Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial.
Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial.
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DOI：
10.1186/s12885-020-07276-4
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发表时间：
2020-10-07
期刊：
影响因子：
3.8
通讯作者：
ProtecT study group
中科院分区：
文献类型：
--
作者：
Sanghera S;Mohiuddin S;Coast J;Garfield K;Noble S;Metcalfe C;Lane JA;Turner EL;Neal D;Hamdy FC;Martin RM;Donovan JL;ProtecT study group
临床上局限性前列腺癌的最佳治疗策略存在争议。使用迄今为止最大的随机对照试验（ProtecT）的中位数10年数据，根据年龄和风险亚组探讨三种主要治疗（根治性放疗、根治性前列腺切除术和主动监测）的终生成本效益。一个决策分析（马尔可夫）模型被开发并告知临床输入。经济评估采用英国NHS的观点，结果是每个质量调整生命年（QALY）获得的成本（以英国为单位），使用EQ-5D-3L进行估计。在三种随机策略及其亚组之间，在整个生命周期内推断的成本和质量aly基本相似，但存在一些重要差异。在所有分析中，主动监测与更高的成本相关，可能与更高的转移率和根治性治疗的变化相关。当从货币角度比较策略的价值（QALY收益和成本）时，对于两个低风险前列腺癌亚组，放疗产生了最大的净货币效益（D 'Amico组为293,446英镑[95% CI£282,811至£299,451]，第1级组为292,736英镑[95% CI£284,074至£297,719]）。然而，敏感性分析强调了分级分组时发现的不确定性，因为放疗的成本效益概率为53%，前列腺切除术的成本效益概率为43%。在中/高风险组中，使用D 'Amico和分级组> = 2，前列腺切除术产生了最大的净经济效益（D 'Amico组为275,977英镑[95% CI£258,630至£285,474]，分级组为271,933英镑[95% CI£237,864至£287,784]）。敏感性分析支持了这一发现。对于65岁以下的男性，前列腺切除术的净收益最大（290,487英镑[95% CI£280,781至£296,281]），对于65岁以上的男性，根治性放疗的净收益最大（201,311英镑[95% CI£195,161至£205,049]），但敏感性分析显示这两种结果都存在相当大的不确定性。从整个生命周期来看，从ProtecT试验推断，根治性放疗和前列腺切除术对低风险前列腺癌来说似乎是划算的，而根治性前列腺切除术对中/高风险前列腺癌来说似乎是划算的，但在一些估计中存在不确定性。需要更长时间的ProtecT试验随访，以减少模型中的不确定性。当前对照试验编号，ISRCTN20141297: http://isrctn.org (14/10/2002)；ClinicalTrials.gov编号：NCT02044172: http://www.clinicaltrials.gov（23/01/2014）。
Optimal management strategies for clinically localised prostate cancer are debated. Using median 10-year data from the largest randomised controlled trial to date (ProtecT), the lifetime cost-effectiveness of three major treatments (radical radiotherapy, radical prostatectomy and active monitoring) was explored according to age and risk subgroups. A decision-analytic (Markov) model was developed and informed by clinical input. The economic evaluation adopted a UK NHS perspective and the outcome was cost per Quality-Adjusted Life Year (QALY) gained (reported in UK£), estimated using EQ-5D-3L. Costs and QALYs extrapolated over the lifetime were mostly similar between the three randomised strategies and their subgroups, but with some important differences. Across all analyses, active monitoring was associated with higher costs, probably associated with higher rates of metastatic disease and changes to radical treatments. When comparing the value of the strategies (QALY gains and costs) in monetary terms, for both low-risk prostate cancer subgroups, radiotherapy generated the greatest net monetary benefit (£293,446 [95% CI £282,811 to £299,451] by D’Amico and £292,736 [95% CI £284,074 to £297,719] by Grade group 1). However, the sensitivity analysis highlighted uncertainty in the finding when stratified by Grade group, as radiotherapy had 53% probability of cost-effectiveness and prostatectomy had 43%. In intermediate/high risk groups, using D’Amico and Grade group > = 2, prostatectomy generated the greatest net monetary benefit (£275,977 [95% CI £258,630 to £285,474] by D’Amico and £271,933 [95% CI £237,864 to £287,784] by Grade group). This finding was supported by the sensitivity analysis. Prostatectomy had the greatest net benefit (£290,487 [95% CI £280,781 to £296,281]) for men younger than 65 and radical radiotherapy (£201,311 [95% CI £195,161 to £205,049]) for men older than 65, but sensitivity analysis showed considerable uncertainty in both findings. Over the lifetime, extrapolating from the ProtecT trial, radical radiotherapy and prostatectomy appeared to be cost-effective for low risk prostate cancer, and radical prostatectomy for intermediate/high risk prostate cancer, but there was uncertainty in some estimates. Longer ProtecT trial follow-up is required to reduce uncertainty in the model. Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
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DOI：
10.1056/nejmoa1311593
发表时间：
2014-03-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Bill-Axelson A;Holmberg L;Garmo H;Rider JR;Taari K;Busch C;Nordling S;Häggman M;Andersson SO;Spångberg A;Andrén O;Palmgren J;Steineck G;Adami HO;Johansson JE
通讯作者：
Johansson JE
影响因子：
3.3
作者：
Brooks, R
通讯作者：
Brooks, R
DOI：
10.1056/nejmoa1801993
发表时间：
2018-05-10
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
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影响因子：
120.7
作者：
Chen, Ronald C.;Basak, Ramsankar;Godley, Paul A.
通讯作者：
Godley, Paul A.
DOI：
10.1056/nejmoa1606221
发表时间：
2016-10-13
期刊：
The New England journal of medicine
影响因子：
--
作者：
Donovan JL;Hamdy FC;Lane JA;Mason M;Metcalfe C;Walsh E;Blazeby JM;Peters TJ;Holding P;Bonnington S;Lennon T;Bradshaw L;Cooper D;Herbert P;Howson J;Jones A;Lyons N;Salter E;Thompson P;Tidball S;Blaikie J;Gray C;Bollina P;Catto J;Doble A;Doherty A;Gillatt D;Kockelbergh R;Kynaston H;Paul A;Powell P;Prescott S;Rosario DJ;Rowe E;Davis M;Turner EL;Martin RM;Neal DE;ProtecT Study Group*
通讯作者：
ProtecT Study Group*