Costs of early adjuvant radiation therapy after radical prostatectomy: a decision analysis.

This analysis was carried out to evaluate the cost-effectiveness of adjuvant radiation therapy (ART) versus observation, using a decision analysis model based primarily upon the published results of the Southwest Oncology Group prospective trial (SWOG 8794).

A decision analysis model was designed to compare ART versus observation over a 10-year time horizon. Probabilities of treatment success, utilization of salvage treatments, and rates of adverse events were taken from published results of SWOG 8794. Cost inputs were based on 2010 Medicare reimbursement rates. Primary outcome measure was incremental cost per prostate-specific antigen (PSA) success (i.e. serum PSA level <0.4 ng/ml).

ART results in a higher PSA success rate than observation with probability of 0.43 versus 0.22. The mean incremental cost per patient for ART versus observation was $6023. The mean incremental cost-effectiveness ratio was $26 983 over the 10-year period.

ART appears cost effective compared with observation based upon this decision analysis model. Future research should consider more costly radiation therapy (RT) approaches, such as intensity-modulated RT, and should evaluate the cost-effectiveness of ART versus early salvage RT.

Annals of oncology : official journal of the European Society for Medical Oncology. 2019 Dec 04 [Epub]

T N Showalter, K A Foley, E Jutkowitz, C D Lallas, E J Trabulsi, L G Gomella, A P Dicker, L T Pizzi

Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center. Electronic address: ., Thomson Reuters Healthcare, Cambridge., Department of Urology, Jefferson Medical College, Kimmel Cancer Center., Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center., School of Pharmacy, Thomas Jefferson University, Philadelphia, USA.