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Effectiveness and cost-effectiveness of prognostic markers in prostate cancer.

Calvert NW, Morgan AB, Catto JW, Hamdy FC, Akehurst RL, Mouncey P, Paisley S - Br. J. Cancer (2003)

Bottom Line: The robustness of the results has been tested using sensitivity analysis.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.

View Article: PubMed Central - PubMed

Affiliation: Fourth Hurdle Consulting Ltd, 2 Fisher Street, London, UK. neillcalvert@fourthhurdle.com

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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Related in: MedlinePlus

Incremental cost-effectiveness ratio (costs per QALY for marker treatment policy vs observation) by test sensitivity and specificity.Table 5Table 5
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fig2: Incremental cost-effectiveness ratio (costs per QALY for marker treatment policy vs observation) by test sensitivity and specificity.Table 5Table 5

Mentions: Given the lack of published sensitivity and specificity values for ploidy in predicting aggressive prostate cancer, the sensitivity of model outputs was tested by varying sensitivity and specificity between the ranges 50% and 100%. The resulting incremental cost-effectiveness ratios (ICERs) for the marker-based treatment policy compared with observation are depicted graphically in Figure 2Figure 2


Effectiveness and cost-effectiveness of prognostic markers in prostate cancer.

Calvert NW, Morgan AB, Catto JW, Hamdy FC, Akehurst RL, Mouncey P, Paisley S - Br. J. Cancer (2003)

Incremental cost-effectiveness ratio (costs per QALY for marker treatment policy vs observation) by test sensitivity and specificity.Table 5Table 5
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2376796&req=5

fig2: Incremental cost-effectiveness ratio (costs per QALY for marker treatment policy vs observation) by test sensitivity and specificity.Table 5Table 5
Mentions: Given the lack of published sensitivity and specificity values for ploidy in predicting aggressive prostate cancer, the sensitivity of model outputs was tested by varying sensitivity and specificity between the ranges 50% and 100%. The resulting incremental cost-effectiveness ratios (ICERs) for the marker-based treatment policy compared with observation are depicted graphically in Figure 2Figure 2

Bottom Line: The robustness of the results has been tested using sensitivity analysis.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.

View Article: PubMed Central - PubMed

Affiliation: Fourth Hurdle Consulting Ltd, 2 Fisher Street, London, UK. neillcalvert@fourthhurdle.com

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.

Show MeSH
Related in: MedlinePlus