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A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer.

Publication ,  Journal Article
Reed, SD; Stewart, SB; Scales, CD; Moul, JW
Published in: Value Health
July 2014

OBJECTIVES: The NADiA ProsVue is a prognostic system that measures prostate-specific antigen slope to identify men at lower risk of clinical recurrence of prostate cancer after radical prostatectomy. We developed a decision-modeling framework to evaluate its cost-effectiveness to guide the use of adjuvant radiotherapy (ART). METHODS: We populated the model using patient-level data and external sources. Patients were classified as intermediate risk or high risk on the basis of Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) nomogram and then stratified by the ProsVue slope (≤2 pg/mL/mo; >2 pg/mL/mo) and receipt of ART. In sensitivity analyses, we varied the effect of the ProsVue slope on the use of ART and other model parameters. RESULTS: The cost-effectiveness of the ProsVue-guided strategy varied widely because of small differences in quality-adjusted life-years (QALYs) at 10 years. In the intermediate-risk group, when the use of ART decreased from 20% (standard care) to 7.5% among patients with a ProsVue slope value of 2 pg/mL/mo or less, the incremental cost-effectiveness ratio was $25,160/QALY. In the high-risk group, the use of ART would have to decrease from 40% (standard care) to 11.5% among those with a ProsVue slope value of 2 pg/mL/mo or less to obtain a ratio of $50,000/QALY. The cost-effectiveness ratios were sensitive to varying benefits of salvage therapy, quality of life, and costs of ART and ProsVue testing. CONCLUSIONS: The effect of the ProsVue system on costs will be dependent on the extent to which ART decreases among men identified as having a low risk of recurrence. Its effect on QALYs will remain conditional on uncertain clinical and quality-of-life benefits associated with ART.

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Published In

Value Health

DOI

EISSN

1524-4733

Publication Date

July 2014

Volume

17

Issue

5

Start / End Page

545 / 554

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Adjuvant
  • Quality-Adjusted Life Years
  • Quality of Life
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate-Specific Antigen
  • Prognosis
 

Citation

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Reed, S. D., Stewart, S. B., Scales, C. D., & Moul, J. W. (2014). A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer. Value Health, 17(5), 545–554. https://doi.org/10.1016/j.jval.2014.04.010
Reed, Shelby D., Suzanne Biehn Stewart, Charles D. Scales, and Judd W. Moul. “A framework to evaluate the cost-effectiveness of the NADiA ProsVue slope to guide adjuvant radiotherapy among men with high-risk characteristics following prostatectomy for prostate cancer.Value Health 17, no. 5 (July 2014): 545–54. https://doi.org/10.1016/j.jval.2014.04.010.
Journal cover image

Published In

Value Health

DOI

EISSN

1524-4733

Publication Date

July 2014

Volume

17

Issue

5

Start / End Page

545 / 554

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Radiotherapy, Adjuvant
  • Quality-Adjusted Life Years
  • Quality of Life
  • Prostatic Neoplasms
  • Prostatectomy
  • Prostate-Specific Antigen
  • Prognosis