Current Practice Least Cost-Effective Option in Prostate Cancer Management

Meg Barbor, MPH

October 2015, Vol 6, No 9 - Economics of Cancer Care


Copenhagen, Denmark—Current follow-up strategy for patients with prostate cancer was found to be the least cost-effective approach in an analysis conducted in Europe.

Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. According to Linda Sharp, PhD, Professor of Cancer Epidemiology, Newcastle University, England, United Kingdom, the growing number of prostate cancer survivors means that this strategy may not be economically sustainable.

Her team analyzed the costs of 3 strategies for prostate cancer follow-up in Ireland, and presented their results at the 2015 Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology meeting.

Ireland has a public and private healthcare system and has an estimated 25,000 men with prostate cancer in a population of 4.6 million people. Therefore, prostate-specific antigen (PSA) testing is very common.

The investigators compared the European Association of Urology (EAU) guidelines for prostate cancer, the National Institute for Health and Care Excellence (NICE) guidelines, and current practice used in the United Kingdom.

They used a Markov model, with a cohort of 1000 men who were treated with curative intent during 10 years.

UK reference costs were used and were discounted at a rate of 5%, and sensitivity analyses were performed on key parameters to explore the impact on the results.

The cost of follow-up per survivor under the current practice guidelines was estimated to be €1150. The cost under the EAU guidelines was €1057, and under the NICE guidelines, €853.

Using current practice as the baseline, “this translates to a reduction of a quarter in follow-up costs over 10 years if they move to the NICE guidelines, and a reduction of just under 10% if they move to the EAU guidelines,” Dr Sharp reported.

Evaluating cost by year, initially, the NICE guidelines were much less expensive compared with the other 2 models. “This is due to less frequent PSA testing,” Dr Sharp added. And after a few years, “you can see the benefit of discharge to primary care in the NICE guidelines, giving it consistently the lowest costs.”

The estimated potential savings to the healthcare system over 10 years with the NICE guidelines is €761,119 compared with current practice, and €236,959 with the EAU guidelines.

“These numbers seem quite small, because it’s quite a small country,” said Dr Sharp. “But in terms of the proportion of the cancer budget, it’s not insubstantial.”

Sensitivity analyses also showed the current practice to be the least cost-­efficient option.

“This is the first comparison of costs and alternative prostate cancer follow-up models in the literature,” Dr Sharp stated. The investigators concluded that cost-savings with follow-up strategies could be possible with less frequent PSA testing, greater involvement of primary care, and discharge from hospital follow-up for survivors without complications.