Cost-effectiveness of hypofractionated versus conventional radiotherapy in patients with intermediate-risk prostate cancer: an ancillary study of the PROstate fractionated irradiation Trial - PROFIT.

To evaluate the cost-effectiveness of moderate Hypofractionated Radiotherapy (H-RT) compared to Conventional Radiotherapy (C-RT) for intermediate-risk PCa.

A prospective randomized clinical trial including 222 patients from six French cancer centers was conducted as an ancillary study of the international PROstate Fractionated Irradiation Trial (PROFIT). We carried-out a cost-effectiveness analysis (CEA) from the payer's perspective, with a time horizon of 48 months. Patients assigned to the H-RT arm received 6000cGy in 20 fractions over 4 weeks, or 7800cGy in 39 fractions over 7 to 8 weeks in the C-RT arm. Patients completed quality of life (QoL) questionnaire: Expanded Prostate Cancer Index Composite (EPIC) at baseline, 24 and 48 months, which were mapped to obtain a EuroQol five-dimensional questionnaire (EQ-5D) equivalent to generate Quality Adjusted Life Years (QALY). We assessed differences in QALYs and costs between the two arms with Generalized Linear Models (GLMs). Costs, estimated in euro (€) 2020, were combined with QALYs to estimate the Incremental Cost-effectiveness ratio (ICER) with non-parametric bootstrap.

Total costs per patien were lower in the H-RT arm compared to the C-RT arm (€3,062 (95% CI: 2,368 to 3,754) versus €4,285 (95% CI: 3,355 to 5,215 , p<0.05). QALY were marginally higher in the H-RT arm, however this difference was not significant: 0.044 (95% CI: - 0.016 to 0.099).

Treating localized prostate cancer with moderate H-RT could reduce national health insurance spending. Adopting such a treatment with an updated reimbursement tariff would result in improving resource allocation in RT management.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2022 Jun 27 [Epub ahead of print]

K Zhou, M Renouf, G Perrocheau, N Magné, I Latorzeff, P Pommier, G Créhange, A Paumier, G Bera, J Martin, C Catton, M Bellanger, S Supiot

Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France. Electronic address: ., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France. Electronic address: ., Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France. Electronic address: ., Department of Radiation Oncology, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France., Department of Radiation Oncology, Pasteur Clinic, Toulouse, France., Department of Radiation Oncology, Léon Bérard Center, Lyon, France., Department of Radiation Oncology, Institut Curie, Paris, France., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Paul Papin, Angers, France., Department of Radiation Oncology, hôpital du Scorff, Groupe Hospitalier Bretagne Sud, Lorient, France., Department of Radiation Oncology, Calvary Mater Hospital, University of Newcastle, Australia., Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Canada., Department of Human and Social Sciences, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France; UMR CNRS6051 Rennes1 - EHESP School of Public Health, France. Electronic address: ., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France. Electronic address: .

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