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Economic evaluation of treatments for patients with localized prostate cancer in Europe : a systematic review
Becerra, Virginia (Universitat Pompeu Fabra)
Ávila, Mónica (CIBER en Epidemiología y Salud Pública. CIBERESP)
Jimenez, Jorge (Institut Hospital del Mar d'Investigacions Mèdiques)
Cortes Sanabria, Laura (Institut Hospital del Mar d'Investigacions Mèdiques)
Pardo, Yolanda (Institut Hospital del Mar d'Investigacions Mèdiques)
Garin, Olatz (Universitat Pompeu Fabra)
Pont, Angels (Institut Hospital del Mar d'Investigacions Mèdiques)
Alonso, Jordi (Institut Hospital del Mar d'Investigacions Mèdiques)
Cots Reguant, Francesc (Institut Hospital del Mar d'Investigacions Mèdiques)
Ferrer, Montse (Universitat Autònoma de Barcelona)

Date: 2016
Abstract: Background: Our objective was to assess the efficiency of treatments in patients with localized prostate cancer, by synthesizing available evidence from European economic evaluations through systematic review. Methods: Articles published 2000-2015 were searched in MEDLINE, EMBASE and NHS EED (Prospero protocol CRD42015022063). Two authors independently selected studies for inclusion and extracted the data. A third reviewer resolved discrepancies. We included European economic evaluations or cost comparison studies, of any modality of surgery or radiotherapy treatments, regardless the comparator/s. Drummond's Checklist was used for quality assessment. Results: After reviewing 8,789 titles, 13 European eligible studies were included: eight cost-utility, two cost-effectiveness, one cost-minimization, and two cost-comparison analyses. Of them, five compared interventions with expectant management, four contrasted robotic with non robotic-assisted surgery, three assessed new modalities of radiotherapy, and three compared radical prostatectomy with brachytherapy. All but two studies scored ≥8 in the quality checklist. Considering scenario and comparator, three interventions were qualified as dominant strategies (active surveillance, robotic-assisted surgery and IMRT), and six were cost-effective (radical prostatectomy, robotic-assisted surgery, IMRT, proton therapy, brachytherapy, and 3DCRT). However, QALY gains in most of them were small. For interventions considered as dominant strategies, QALY gain was 0. 013 for active surveillance over radical prostatectomy; and 0. 007 for robotic-assisted over non-robotic techniques. The highest QALY gains were 0. 57-0. 86 for radical prostatectomy vs watchful waiting, and 0. 72 for brachytherapy vs conventional radiotherapy. Conclusions: Currently, relevant treatment alternatives for localized prostate cancer are scarcely evaluated in Europe. Very limited available evidence supports the cost-effectiveness of radical prostatectomy over watchful waiting, brachytherapy over radical prostatectomy, and new treatment modalities over traditional procedures. Relevant disparities were detected among studies, mainly based on effectiveness. These apparently contradictory results may be reflecting the difficulty of interpreting small differences between treatments regarding QALY gains.
Note: We would like to thank Aurea Martin for her writing assistance, proofreading, manuscript editing and the submission preparation process. Financial support for this study was provided by Instituto de Salud Carlos III FEDER: Fondo Europeo de Desarrollo Regional (FIS PI08/90090 and PI13/00412); Agència d'Informació, Avaluació i Qualitat en Salut (AIAQS), 436/05/2008; Ministerio de Ciencia e Innovación (PTAT2011-04891); and DIUE of Generalitat de Catalunya (2014 SGR 748). The funding agreements ensure the authors' independence in designing the study, interpreting the data, and writing and publishing the report.
Note: Número d'acord de subvenció AGAUR/2014 SGR 748
Note: Número d'acord de subvenció MICINN/PTAT2011-04891
Note: Número d'acord de subvenció ISCIII/FIS/PI08/90090
Note: Número d'acord de subvenció ISCIII/FIS/PI13/00412
Note: Número d'acord de subvenció AIAQS/436/05/2008
Rights: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Language: Anglès
Document: article ; recerca ; publishedVersion
Subject: Cost-effectiveness analysis ; Cost-utility analysis ; Cost-benefit analysis ; Protatic neoplasms ; QALY ; Quality-adjusted life years
Published in: BMC health services research, Vol. 16, Núm. 1 (March 2016) , p. 1-13, ISSN 1472-6963

DOI: 10.1186/s12913-016-1781-z
PMID: 27716267

13 p, 781.5 KB

The record appears in these collections:
Articles > Research articles
Articles > Published articles

 Record created 2019-04-04, last modified 2021-03-19

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