Economic evaluation of diagnostic localization following biochemical prostate cancer recurrence.
Int J Technol Assess Health Care
; 30(4): 345-53, 2014 Oct.
Article
en En
| MEDLINE
| ID: mdl-25399914
ABSTRACT
OBJECTIVES:
The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy.METHODS:
Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies (i) using the new diagnostic to guide therapy versus (ii) current usual care-using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare.RESULTS:
The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI] 1.24-2.64) QALYs with added costs of USD 15,595 (95 percent UI USD -6,330-44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI USD -2,947-22,372). RESULTS were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity.CONCLUSION:
This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
Asunto principal:
Neoplasias de la Próstata
/
Neoplasia Residual
/
Imagen Molecular
Tipo de estudio:
Diagnostic_studies
/
Health_economic_evaluation
/
Health_technology_assessment
/
Prognostic_studies
Aspecto:
Patient_preference
Límite:
Aged
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Int J Technol Assess Health Care
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
Año:
2014
Tipo del documento:
Article