Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Abstract

Context Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. Objective To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. Evidence acquisition We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. Evidence synthesis RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer’s perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the limited comparative data on outcomes. Using the Grades of Recommendation, Assessment, Development and Evaluation approach, the quality of evidence was low for RARP and IMRT, and very low for proton beam therapy. Conclusions Treatment with new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective.

National cohort study comparing severe medium‐term urinary complications after robot‐assisted vs laparoscopic vs retropubic open radical prostatectomy

“…Robot‐assisted prostate cancer surgery has been rapidly adopted in many countries and has become the most common type of RP within the English NHS . Attempts to estimate whether the increased healthcare costs associated with RARP are cost‐effective are still hampered by uncertainty around improvements in outcomes such as cancer control and medium‐term morbidity . Our results emphasize that there are additional advantages to RARP in the long term, which not only improve patient outcomes but reduce subsequent treatment costs in healthcare systems.…”

Health Economic Analysis of Open and Robot-assisted Laparoscopic Surgery for Prostate Cancer Within the Prospective Multicentre LAPPRO Trial

“…However, with the high cost of robotic systems, studies providing evidence of benefits outweighing the increased cost are warranted. Indeed, literature in the area is accumulating [1][2][3]. The current study is a cost analysis based on the clinical trial LAPPRO (Laparoscopic Prostatectomy Robot Open), which is a large prospective, nonrandomised, multicentre, direct comparison between robot-assisted laparoscopic prostatectomy (RALP) and retropubic radical prostatectomy (RRP).…”

Particle therapy for prostate cancer: The past, present and future

“…Of note, patients can receive particle beam RT without paying expensive fees, and the cost of this advanced medical treatment is similar to those of other RTs, such as IMRT and brachytherapy. The cost–benefit of particle beam RT was previously considered inferior to that of photon beam RT, but with development of this treatment modality, particle beam RT might now provide a potential cost‐effective treatment in Japan . However, to establish the routine use of particle beam RT worldwide, it is still necessary to further reduce the size and cost of the device for particle beam RT.…”

“…The cost-benefit of particle beam RT was previously considered inferior to that of photon beam RT, but with development of this treatment modality, particle beam RT might now provide a potential cost-effective treatment in Japan. 48,49 However, to establish the routine use of particle beam RT worldwide, it is still necessary to further reduce the size and cost of the device for particle beam RT.…”