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Health services - Research lines Jordi Alonso

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Cost effectiveness and cost utility for the main treatments for clinically localized prostate cancer: a 7- years follow-up study

Research team: Ferrer M (IP), Becerra V, Cunillera O, Guedea F, Pera Fàbregas J, Suàrez Novo JF, et al.

Summary: Despite the high incidence of prostate cancer (the second most frequently diagnosed tumour in men of the European Union), there is a noticeable lack of high quality scientific evidence on the effectiveness of the treatments for localized tumours.

Aims: To carry out cost effectiveness and cost utility analysis of the three most established therapeutic options for clinically localized prostate cancer (Radical Prostatectomy, Prostate Brachytherapy or 3D External Conformal Radiotherapy) taking into account accumulated direct costs for 7 years after treatment, from the perspective of the health care services provider.

Specific goals:

• Evaluating the effectiveness at the 6th and 7th year of follow-up of the three most established therapeutic options (Radical Prostatectomy, Prostatic Brachytherapy and 3D External Conformal Radiotherapy), according to the different outcomes: biochemical relapses, secondary effects and health related quality of life.
• Estimating the accumulated cost until 7 years after the localized prostate cancer diagnosis, according to the applied therapeutic option (Radical Prostatectomy, Prostatic Brachytherapy and 3D External Conformal Radiotherapy), risk group and age.
• Cost Effectiveness Analysis (CEA) at 7 years of the three most established therapeutic options (Radical Prostatectomy, Prostatic Brachytherapy and 3D External Conformal Radiotherapy), according to the different outcomes.
• Estimating the Quality-Adjusted Life Years (QALY) through the SF-6D preference-based index and the direct measure of the patients’ preferences: Standard Gamble (SG), Time Trade-Off (TTO) and Willingness-to-Pay (WTP).
• Cost-Utility Analysis (CUA) at 7 years of treatment for localized prostate cancer using the QALY obtained through direct and indirect (SF-6D) methods.

Methods: Prospective follow-up study in the 6th and 7th year after treatment of 766 patients diagnosed of clinically localized prostate cancer (T1 or T2), recruited consecutively in 10 Spanish hospital departments (2 Urology departments and 8 Radiotherapy Oncology departments). The decision on the choice of treatment was carried out jointly between doctor and patient, with the following distribution: 206 Surgery, 324 Brachytherapy and 236 External Radiotherapy. The initial evaluation, before treatment, and follow-up assessments over 5 years have been completed. The effectiveness evaluation will be performed in the 6th and 7th years, including the different outcome measures considered relevant in clinically localized prostate cancer: survival free of biochemical relapse, side effects, health related quality of life and Quality-Adjusted Life Years (QALY). The cost analysis shall be performed from the perspective of the health care services provider, direct tangible costs shall be considered by ABC (Activity-Based-Costing) approximation.

Key Words: Cost effectiveness, cost utility, biochemical relapse, clinically localized prostate cancer, health related, quality of life.

Funding a) Agència d’Avaluació de Tecnologia i Recerca Mèdiques; 436/05/2008; 2009-2012. b) Fondo de Investigación Sanitaria (ISCIII), PI08/90090; 2008-2010).