Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-14T13:22:25.470Z Has data issue: false hasContentIssue false
  • English
  • Français

ECONOMIC EVALUATION OF DIAGNOSTIC LOCALIZATION FOLLOWING BIOCHEMICAL PROSTATE CANCER RECURRENCE

Published online by Cambridge University Press:  17 November 2014

Daniel A. Barocas ,
Mark E. Bensink ,
Kristin Berry ,
Zahra Musa ,
Carolyn Bodnar ,
Robert Dann  and
Scott D. Ramsey
Daniel A. Barocas
Affiliation:
Vanderbilt University Medical Center
Mark E. Bensink
Affiliation:
Fred Hutchinson Cancer Research Center
Kristin Berry
Affiliation:
Fred Hutchinson Cancer Research Center
Zahra Musa
Affiliation:
Fred Hutchinson Cancer Research Center
Carolyn Bodnar
Affiliation:
GE Healthcare
Robert Dann
Affiliation:
GE Healthcare
Scott D. Ramsey
Affiliation:
Fred Hutchinson Cancer Research [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Prostate neoplasmsNeoplasm recurrenceLocalNeoplasm metastasisMolecular imagingModelsEconomic
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 4 , October 2014 , pp. 345 - 353
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Nunn, AD. Molecular imaging and personalized medicine: An uncertain future. Cancer Biother Radiopharm. 2007;22:722–739. PubMed PMID: 18158763.Google ScholarPubMed
2. Hillman, BJ, Goldsmith, JC. The uncritical use of high-tech medical imaging. N Engl J Med. 2010;363:4–6. PubMed PMID: ISI:000279343000002.CrossRefGoogle ScholarPubMed
3. Congressional Budget Office. Budget options, volume I, health care 2008. http://www.cbo.gov/publication/41747 (accessed April 3, 2012).Google Scholar
4. Government Accountability Office. GAO 08–452, Medicare Part B Imaging Services. Rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices 2008. http://www.gao.gov/highlights/d08452high.pdf (accessed April 3, 2012).Google Scholar
5. America's Health Insurance Plans. Ensuring quality through appropriate use of diagnostic imaging 2008. www.ahip.org/content/default.aspx?docid=24057 (accessed April 3, 2012).Google Scholar
6. Medicare Payment Advisory Commission. Report to the Congress. Medicare payment policy 2009. www.medpac.gov/documents/mar09_entirereport.pdf (accessed April 3, 2012).Google Scholar
7. Winter, A, Ray, N. Paying accurately for imaging services in Medicare. Health Aff (Millwood). 2008;27:1479–1490.CrossRefGoogle ScholarPubMed
8. Levin, DC, Rao, VM, Parker, L, Frangos, AJ, Sunshine, JH. Bending the curve: The recent marked slowdown in growth of noninvasive diagnostic imaging. AJR Am J Roentgenol. 2011;196:W25–W29. PubMed PMID: 21178027.CrossRefGoogle ScholarPubMed
9. Caire, AA, Sun, L, Ode, O, et al. Delayed prostate-specific antigen recurrence after radical prostatectomy: How to identify and what are their clinical outcomes? Urology. 2009;74:643–7. PubMed PMID: 19501891.CrossRefGoogle ScholarPubMed
10. Stephenson, AJ, Shariat, SF, Zelefsky, MJ, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 2004;291:1325–1332. PubMed PMID: 15026399.CrossRefGoogle ScholarPubMed
11. Bensink, M, Wyatt, K, Musa, Z, et al. Using economic evaluation to guide technology development decisions in nuclear medicine: Functional imaging for identifying non-response to bevacizumab in patients with advanced colorectal cancer. J Nucl Med. 2013. In press.Google Scholar
12. Sculpher, M, Drummond, M, Buxton, M. The iterative use of economic evaluation as part of the process of health technology assessment. J Health Serv Res Policy. 1997;2:26–30.CrossRefGoogle ScholarPubMed
13. Warburton, R. Patient saftey-how much is enough? Health Policy. 2005;75:223–232.CrossRefGoogle Scholar
14. Vallejo-Torres, L, Steuten, LM, Buxton, MJ, et al. Integrating health economics modeling in the product development cycle of medical devices: A Bayesian approach. Int J technol assess health care. 2008;24:459–464. PubMed PMID: 18828941.CrossRefGoogle ScholarPubMed
15. Schuster, DM, Nieh, PT, Jani, AB, et al. Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography and (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for recurrent prostate carcinoma: Results of a prospective clinical trial. J Urol. 2014;191:1446–1453.CrossRefGoogle Scholar
16. Husereau, D, Drummond, M, Petrou, S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29:117–122.CrossRefGoogle ScholarPubMed
17. Stewart, ST, Lenert, L, Bhatnagar, V, Kaplan, RM. Utilities for prostate cancer health states in men aged 60 and older. Med Care. 2005;43:347–355. PubMed PMID: 15778638.CrossRefGoogle ScholarPubMed
18. Trock, BJ, Han, M, Freedland, SJ, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. 2008;299:2760–2769. PubMed PMID: 18560003. Pubmed Central PMCID: NIHMS283299.CrossRefGoogle ScholarPubMed
19. Lu-Yao, G, Moore, DF, Oleynick, JU, DiPaola, RS, Yao, S-L. Population based study of hormonal therapy and survival in men with metastatic prostate cancer. J Urol. 2007;177:535–539. PubMed PMID: 17222628.CrossRefGoogle ScholarPubMed
20. Penson, DF, Moul, JW, Evans, CP, et al. The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: Findings from a retrospective analysis of health plan data. J Urol. 2004;171 (Pt 1):2250–2254. PubMed PMID: 15126796.CrossRefGoogle ScholarPubMed
21. Schuster, DM, Savir-Baruch, B, Nieh, PT, et al. Detection of recurrent prostate carcinoma with anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid PET/CT and 111In-capromab pendetide SPECT/CT. Radiology. 2011;259:852–861.CrossRefGoogle ScholarPubMed
22. Stephenson, AJ, Scardino, PT, Kattan, MW, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25:2035–2041.CrossRefGoogle ScholarPubMed
23. Nanni, C, Schiavina, R, Boschi, S, et al. Comparison of 18F-FACBC and 11C-choline PET/CT in patients with radically treated prostate cancer and biochemical relapse: Preliminary results. Eur J Nucl Med Mol Imaging. 2013;40:11–17.CrossRefGoogle ScholarPubMed
24. Beresford, MJ, Gillatt, D, Benson, RJ, Ajithkumar, T. A systematic review of the role of imaging before salvage radiotherapy for post-prostatectomy biochemical recurrence. Clin Oncol (R Coll Radiol). 2010;22:46–55. PubMed PMID: 19948393.CrossRefGoogle ScholarPubMed
25. Giovacchini, G, Picchio, M, Briganti, A, et al. [11C]choline positron emission tomography/computerized tomography to restage prostate cancer cases with biochemical failure after radical prostatectomy and no disease evidence on conventional imaging. J Urol. 2010;184:938–943. PubMed PMID: 20643445.CrossRefGoogle Scholar
26. Okotie, OT, Aronson, WJ, Wieder, JA, et al. Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol. 2004;171 (Pt 1):2260–2264. PubMed PMID: 15126798.CrossRefGoogle ScholarPubMed
27. Arias, E. United States life tables, 2007. Natl Vital Stat Rep. 2011;59:1–60. PubMed PMID: 22070012.Google ScholarPubMed
28. US Department of labor. Consumer price index medical (CPI-M) January 1947 to July 2012. Washington, DC: Bureau of labor statistics, US Department of labor; 2012.Google Scholar
29. Murphy, M. Proximity to death and health care costs. In: McGuire, A, Costa-Font, J, eds. The LSE companion to health policy. Northampton, MA: Edwards Elgar Publishing; 2012:221–232.Google Scholar
30. Morrison, RS, Penrod, JD, Cassel, JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168:1783–90. PubMed PMID: 18779466.CrossRefGoogle ScholarPubMed
31. Tefilli, MV, Gheiler, EL, Tiguert, R, et al. Quality of life in patients undergoing salvage procedures for locally recurrent prostate cancer. J Surg Oncol. 1998;69:156–161. PubMed PMID: 9846502.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
32. Sanda, MG, Dunn, RL, Michalski, J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 20;358:1250–1261. PubMed PMID: 18354103.CrossRefGoogle ScholarPubMed
33. Kyrdalen, AE, Dahl, AA, Hernes, E, Småstuen, MC, Fosså, SD. A national study of adverse effects and global quality of life among candidates for curative treatment for prostate cancer. BJU Int. 2013;111:221–232.CrossRefGoogle ScholarPubMed
34. Potosky, AL, Davis, WW, Hoffman, RM, et al. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: The prostate cancer outcomes study. J Natl Cancer Inst. 2004;96:1358–67. PubMed PMID: 15367568.CrossRefGoogle ScholarPubMed
35. Lentzner, HR, Pamuk, ER, Rhodenhiser, EP, Rothenberg, R, Powell-Griner, E. The quality of life in the year before death. Am J Public Health. 1992;82:1093–1098. PubMed PMID: 1386195.CrossRefGoogle ScholarPubMed
36. Liao, Y, McGee, DL, Cao, G, Cooper, RS. Quality of the last year of life of older adults: 1986 vs 1993. JAMA. 2000;283:512–518. PubMed PMID: 10659878.CrossRefGoogle ScholarPubMed
37. Benjamins, MR, Hummer, RA, Eberstein, IW, Nam, CB. Self-reported health and adult mortality risk: An analysis of cause-specific mortality. Soc Sci Med. 2004;59:1297–1306. PubMed PMID: 15210100.CrossRefGoogle ScholarPubMed
38. DeSalvo, KB, Fan, VS, McDonell, MB, Fihn, SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40:1234–1246. PubMed PMID: 16033502.CrossRefGoogle ScholarPubMed
39. Myint, PK, Luben, RN, Surtees, PG, et al. Relation between self-reported physical functional health and chronic disease mortality in men and women in the European Prospective Investigation into Cancer (EPIC-Norfolk): A prospective population study. Ann Epidemiol. 2006;16:492–500. PubMed PMID: 16005244.CrossRefGoogle ScholarPubMed
40. Grosse, SD. Assessing cost-effectiveness in healthcare: History of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8:165–178. PubMed PMID: 20528406.CrossRefGoogle Scholar
41. Torgerson, DJ, Raftery, J. Economic notes. Discounting. BMJ. 1999;319:914–915. PubMed PMID: 10506056.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Barocas Supplementary Material

Figure S1

Download Barocas Supplementary Material(Image)
Image 80.1 KB
Supplementary material: Image

Barocas Supplementary Material

Figure S2

Download Barocas Supplementary Material(Image)
Image 130 KB
Supplementary material: Image

Barocas Supplementary Material

Figure S3

Download Barocas Supplementary Material(Image)
Image 64.2 KB
Supplementary material: File

Barocas Supplementary Material

Table S1

Download Barocas Supplementary Material(File)
File 19.7 KB
Supplementary material: File

Barocas Supplementary Material

Table S2

Download Barocas Supplementary Material(File)
File 33 KB