TY - JOUR
T1 - Evaluating the Cost-Effectiveness of Hydrogel Rectal Spacer in Prostate Cancer Radiation Therapy
AU - Levy, Joseph F.
AU - Khairnar, Rahul
AU - Louie, Alexander V.
AU - Showalter, Timothy N.
AU - Mullins, C. Daniel
AU - Mishra, Mark V.
N1 - Funding Information:
Sources of support: This research was funded with an American Society of Radiation Oncology Comparative Effectiveness grant.Conflicts of interest: Dr Mishra reports grants from the American Society of Radiation Oncology Comparative Effectiveness Research during the conduct of the study; personal fees from Varian; and other fees from Adverum and GE outside the submitted work. Dr Mullins reports grants from AlphaNet and Novartis; personal fees from Bayer, Boehringer-Ingelheim, Illumina, Insmed, Janssen/Johnson & Johnson, MundiPharma, Pfizer, Regeneron, and Sanofi-Aventis; and grants and personal fees from Merck outside the submitted work.
Funding Information:
Sources of support: This research was funded with an American Society of Radiation Oncology Comparative Effectiveness grant.
Funding Information:
Conflicts of interest: Dr Mishra reports grants from the American Society of Radiation Oncology Comparative Effectiveness Research during the conduct of the study; personal fees from Varian; and other fees from Adverum and GE outside the submitted work. Dr Mullins reports grants from AlphaNet and Novartis; personal fees from Bayer, Boehringer-Ingelheim, Illumina, Insmed, Janssen/Johnson & Johnson, MundiPharma, Pfizer, Regeneron, and Sanofi-Aventis; and grants and personal fees from Merck outside the submitted work.
Publisher Copyright:
© 2018
PY - 2019/3
Y1 - 2019/3
N2 - Purpose: A hydrogel rectal spacer (HRS) is a medical device that is approved by the U.S. Food and Drug Administration to increase the separation between the prostate and rectum. We conducted a cost-effectiveness analysis of HRS use for reduction in radiation therapy (RT) toxicities in patients with prostate cancer (PC) undergoing external beam RT (EBRT). Methods and Materials: A multistate Markov model was constructed from the U.S. payer perspective to examine the cost-effectiveness of HRS in men with localized PC receiving EBRT (EBRT alone vs EBRT + HRS). The subgroups analyzed included site of HRS placement (hospital outpatient, physician office, ambulatory surgery center) and proportion of patients with good baseline erectile function (EF). Data on EF, gastrointestinal and genitourinary toxicities incidence, and potential risks associated with HRS implantation were obtained from a recently published randomized clinical trial. Health utilities and costs were derived from the literature and the 2018 Physician Fee Schedule and were discounted 3% annually. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of RT. Probabilistic sensitivity analysis and value-based threshold analyses were conducted. Results: The per-patient 5-year incremental cost for spacers administered in a hospital outpatient setting was $3578, and the incremental effectiveness was 0.0371 QALYs. The incremental cost-effectiveness ratio was $96,440/QALY for patients with PC undergoing HRS insertion in a hospital and $39,286/QALY for patients undergoing HRS insertion in an ambulatory facility. For men with good baseline EF, the incremental cost-effectiveness ratio was $35,548/QALY and $9627/QALY in hospital outpatient and ambulatory facility settings, respectively. Conclusions: Based on the current Medicare Physician Fee Schedule, HRS is cost-effective at a willingness to pay threshold of $100,000. These results contain substantial uncertainty, suggesting more evidence is needed to refine future decision-making.
AB - Purpose: A hydrogel rectal spacer (HRS) is a medical device that is approved by the U.S. Food and Drug Administration to increase the separation between the prostate and rectum. We conducted a cost-effectiveness analysis of HRS use for reduction in radiation therapy (RT) toxicities in patients with prostate cancer (PC) undergoing external beam RT (EBRT). Methods and Materials: A multistate Markov model was constructed from the U.S. payer perspective to examine the cost-effectiveness of HRS in men with localized PC receiving EBRT (EBRT alone vs EBRT + HRS). The subgroups analyzed included site of HRS placement (hospital outpatient, physician office, ambulatory surgery center) and proportion of patients with good baseline erectile function (EF). Data on EF, gastrointestinal and genitourinary toxicities incidence, and potential risks associated with HRS implantation were obtained from a recently published randomized clinical trial. Health utilities and costs were derived from the literature and the 2018 Physician Fee Schedule and were discounted 3% annually. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of RT. Probabilistic sensitivity analysis and value-based threshold analyses were conducted. Results: The per-patient 5-year incremental cost for spacers administered in a hospital outpatient setting was $3578, and the incremental effectiveness was 0.0371 QALYs. The incremental cost-effectiveness ratio was $96,440/QALY for patients with PC undergoing HRS insertion in a hospital and $39,286/QALY for patients undergoing HRS insertion in an ambulatory facility. For men with good baseline EF, the incremental cost-effectiveness ratio was $35,548/QALY and $9627/QALY in hospital outpatient and ambulatory facility settings, respectively. Conclusions: Based on the current Medicare Physician Fee Schedule, HRS is cost-effective at a willingness to pay threshold of $100,000. These results contain substantial uncertainty, suggesting more evidence is needed to refine future decision-making.
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U2 - 10.1016/j.prro.2018.10.003
DO - 10.1016/j.prro.2018.10.003
M3 - Article
C2 - 30342180
AN - SCOPUS:85057836742
SN - 1879-8500
VL - 9
SP - e172-e179
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 2
ER -