Study: Adjuvant radiotherapy effective, cost-effective for prostate cancer

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Adjuvant radiation therapy administered early after radical prostatectomy is more effective than observation, at a mean additional cost of $6,023, resulting in a 10-year incremental cost-effectiveness ratio of $26,983, according to a study published June 9 in the Annals of Oncology.

Prostate cancer is the most common type of cancer in American males besides skin cancer, with 217,730 projected diagnoses for 2010 at an estimated cost of $12 billion, according to T.N. Showalter, MD, from the department of radiation oncology at Jefferson Medical College in Philadelphia, and colleagues. Showalter and colleagues noted that despite evidence that adjuvant radiation therapy (ART) following radical prostatectomy improves biochemical progression-free survival and overall survival, fewer than 20 percent of eligible patients receive the treatment.

“From the payors’ perspective, the added financial costs associated with ART are a consideration,” the authors stated.

Using recent data from the Southwest Oncology Group randomized trial comparing ART to observation, Showalter and colleagues evaluated the cost-effectiveness of ART. Costs were based on 2010 Medicare reimbursement rates, while effectiveness was determined based on data from 242 of 431 enrolled patients. Treatment success was defined as the absence of prostate-specific antigen (PSA) failure (PSA greater than or equal to 0.4 ng/ml).

ART resulted in a 10-year PSA success rate of 0.44, compared with 0.21 for observation. The mean cost of ART was $15,900 versus $9,876 for observation. This resulted in an incremental cost-effectiveness ratio of $2,698, or $26,983 over 10 years.

“Based upon our decision analytic model, ART was both more costly and more effective than observation with each additional PSA success achieved at a cost of $26,983 over a 10-year time horizon,” Showalter and colleagues explained.

The authors said that their findings “lend further support to ART,” arguing that the $26,983 cost-effectiveness ratio is “reasonable in consideration of the health gains achieved.”

“In conclusion, ART is an effective and cost-effective strategy for appropriately selected [prostate cancer] patients,” Showalter and colleagues concluded. “Future research should focus on the comparative effectiveness and cost-effectiveness of ART versus early SRT and should incorporate comprehensive, prospectively collected costs incurred by medication charges and outpatient healthcare utilization, as well as on quality of life gains.”