AUTHOR=He Jiaoxue , Wang Qingfeng , Hu Qiancheng , Li Changlin 

TITLE=Cost-effectiveness analysis of ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate- to high-risk localized prostate cancer

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.841356

DOI=10.3389/fonc.2022.841356

ISSN=2234-943X

ABSTRACT=Background: Radiotherapy is an effective curative treatment option for
intermediate-to-high-risk localized prostate cancer. According to
HYPO-RT-PC trial (ISRCTN45905321) ，there was no significant
difference in 5 years of follow-up failure-free survival,overall
survival,urinary toxicity,bowel toxicity, erectile function decreased
between ultra-hypofractionated radiotherapy with conventionally
fractionated radiotherapy, except that the incidence of urinary toxicity in
ultra-hypofractionated radiotherapy was higher at 1 years follow-up. We
evaluated the cost-effectiveness of ultra-hypofractionated radiotherapy
and conventionally fractionated radiotherapy for
intermediate-to-high-risk localized prostate cancer from the Chinese
payer perspective. Methods: We developed a Markov model with a 15-year time horizon to
compare the cost and effectiveness of ultra-hypofractionated radiotherapy
with those of conventionally fractionated radiotherapy for localized
intermediate-to-high-risk prostate cancer. Outcomes were measured in
quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio
(ICER), and willingness-to-pay (WTP). Univariable and probability
sensitivity analyses were performed to evaluate the robustness of the
Markov model.
Results: Based on the Markov model, the conventionally fractionated
radiotherapy yielded 2.32 QALYs compared with 2.14 QALYs in the
ultra-hypofractionated radiotherapy in China. The cost of
ultra-hypofractionated radiotherapy was found to be decreased by about
14% folds ($4251.04) in comparison to that of conventionally
fractionated radiotherapy. The ICER of conventionally fractionated
radiotherapy versus the ultra-hypofractionated radiotherapy was
$23,616.89 per QALY in China. The failure-free survival (FFS) with
grade two or worse urinary toxicity and the discount rate per annum were
the most sensitive parameters utilized in the ultra-hypofractionated
radiotherapy. The cost effectiveness acceptability curve showed that
conventionally fractionated radiotherapy had a 57.7% probability of
being cost-effective under the Chinese WTP threshold. Conclusion: From the perspective of the Chinese payers, the ultra-hypofractionated radiotherapy was not a cost-effective strategy
compared with the conventionally fractionated radiotherapy for patients
with localized intermediate-to-high-risk prostate cancer from the
perspective of the Chinese payers.Nevertheless, reduction of the grade
two or worse urinary toxicity of the ultra-hypofractionated radiotherapy
could alter the results. Keywords: cost-effectiveness analysis, ultra-hypofractionated
radiotherapy, conventionally fractionated radiotherapy, prostate cancer,
Markov model.