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. 2003 Jan 13;88(1):31-5.
doi: 10.1038/sj.bjc.6600630.

Effectiveness and cost-effectiveness of prognostic markers in prostate cancer

N W Calvert  1 , A B Morgan, J W F Catto, F C Hamdy, R L Akehurst, P Mouncey, S Paisley
Affiliations

Effectiveness and cost-effectiveness of prognostic markers in prostate cancer

N W Calvert et al. Br J Cancer. .

Abstract

This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of 'monitoring' (observation), radical prostatectomy, or a selection-based management policy using DNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of pound 12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades -7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs.

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Figures

Figure 1
Figure 1
Markov representation of early localised prostate.
Figure 2
Figure 2
Incremental cost-effectiveness ratio (costs per QALY for marker treatment policy vs observation) by test sensitivity and specificity.
Figure 3
Figure 3
Threshold analysis showing cost per QALY of £30000 for ploidy marker selection policy compared with observation by test sensitivity and specificity.
See this image and copyright information in PMC

References

    1. Aus G, Hugosson J (1997) Fifteen-year survival with prostate cancer in Sweden. JAMA 278: 205–206 - PubMed
    1. Bostwick DG, Grignon DJ, Hammond ME, Amin MB, Cohen M, Crawford D, Gospadarowicz M, Kaplan RS, Miller DS, Montironi R, Pajak TF, Pollack A, Srigley JR, Yarbro JW (2000) Prognostic factors in prostate cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124: 995–1000 - PubMed
    1. Cantor SB, Spann SJ, Volk RJ, Cardenas MP, Warren MM (1995) Prostate cancer screening: a decision analysis. J Fam Pract 41: 33–41 - PubMed
    1. Chamberlain J, Melia J, Moss S, Brown J (1997) The diagnosis, management, treatment and costs of prostate cancer in England and Wales. Health Technol Assess 1(3) - PubMed
    1. Chodak GW, Thisted RA, Gerber GS, Johansson JE, Adolfsson J, Jones GW, Chisholm GD, Moskovitz B, Livne PM, Warner J (1994) Results in conservative management of clinically localised prostate cancer. N Engl J Med 330: 242–248 - PubMed

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