Prostate radiotherapy/androgen deprivation therapy is cost-effective in prostate cancer


Adding prostate radiation therapy to androgen deprivation therapy appears to be cost-effective in patients with hormone-responsive low-volume metastatic prostate cancer.

According to a study published in Open JAMA Network.

Adding PRT to ADT resulted in an increase of 0.16 quality-adjusted life years (QALYs; 95% CI, 0.15-0.17) and a cost reduction of $19,472 (95% CI, $16,333 to $22,611) compared to ADT alone. The researchers reported similar results with a 6-week split diet, noting a savings of $27,885 (95% CI, $23,272 to $32,498) and a gain of 0.18 QALYs (95% CI, 0.17-0.19). After 37 months of follow-up, researchers reported a QALY gain of 0.81 (95% CI, 0.73-0.89) and a savings of $30,229 (95% CI, $23,096-37,362 $) with lifetime tracking.

“For patients with newly diagnosed low-burden mHSPC, this economic evaluation supports PRT as a cost-effective treatment. The results suggest that adjustments in HR [hazard ratio] to progress in the [phase 2/3] STAMPEDE-H assay [NCT00268476] were associated with the cost-effectiveness of PRT. Our model was informed by high-quality data, and the addition of PRT to ADT was a dominant strategy over ADT alone across a wide range of hypotheses,” the investigators wrote.

The analysis was based on results from the STAMPEDE-H trial, which included 2061 patients. Economic evaluation was performed with a microsimulation model to determine the cost-effectiveness of the two treatment regimens. A simulated cohort of 10,000 patients with low-volume disease was assembled, and from January 2019 to July 2020, investigators extracted and analyzed patient data. The median age of the patients was 68 years old.

In the STAMPEDE-H trial, patients were randomized to receive standard of care ADT plus or minus PRT. PRT was administered at 55 Gy in 20 daily fractions at 2.75 Gy for 4 weeks or 36 Gy for 6 consecutive weekly fractions of 6 Gy. In patients with low metastatic burden, overall survival (OS) was improved in both regimens (HR, 0.68; 95% CI, 0.52-0.90; P = 0.007). In addition, the OS rate at 3 years was 81% in the PRT group versus 73% in the comparator group.

The investigators found that the univariate sensitivity analysis was sensitive to heart rate for the initial progression that was associated with PRT. Investigators noted an association between PRT and improved QALYs and reduced costs for HR less than 0.79. Overall, the model parameters varied, but were not significantly changed because no thresholds were encountered.

A cost increase of $132,908 (95% CI, $111,482 to $154,334) was observed in patients who received abiraterone and ADT, and abiraterone plus PRT resulted in a cost increase of $112,982 (95% CI $94,768 to $131,196) at diagnosis. Additionally, the net cost savings with PRT were similar ($21,996; 95% CI $18,450 to $25,541) and QALY gains were similar to the baseline cases ($0.18; 95% CI %, 0.17-0.19), which may indicate a similar benefit associated with abiraterone between the arms.


Lester-Coll NH, Ades S, Yu JB, Atherly A, Wallace HJ, Sprague BL. Cost-effectiveness of prostate radiation therapy in men with newly diagnosed metastatic low-burden prostate cancer. JAMA Netw Open. 2021;4(1):e2033787. doi:10.1001/jamanetworkopen.2020.33787


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