Background

This study supports a value-based approach to prostate cancer (PCa) treatment by systematically reviewing economic evaluations that compare the cost and cost-effectiveness of low-dose-rate brachytherapy (LDR-BT) with that of other treatment options for localised and locally advanced PCa.

Methods

Studies published between 2008 and 2023 were searched for in MEDLINE, EMBASE and Tufts Medical Center’s Cost-Effectiveness Analysis (CEA) Registry (Prospero protocol CRD42023-442027). Two reviewers independently screened the title and abstracts based on agreed inclusion and exclusion criteria, followed by full-text screening. The Drummond checklist was used to critically appraise the quality of the included studies.

Results

After screening 453 records, 36 were sought for retrieval and 14 eligible studies included. Of them, 11 compared treatments for low- and/or favourable intermediate-risk PCa, 2 compared options for unfavourable intermediate- and/or high-risk disease and 1 analysed treatments for both risk groups. Considerable heterogeneity was seen in the populations, perspectives, time horizons, costs and outcomes data used. If the oncological outcomes of standard treatment approaches are considered equivalent, LDR-BT was the most cost-effective type of radiation therapy (RT) in 9 (75%) of 12 studies, was more cost-effective than radical prostatectomy (RP) in 6 (67%) of 9 studies and, depending on the time horizon, was more cost-effective than active surveillance (AS) in 3 (60%) of 5 studies. LDR-BT was more cost-effective than high-dose-rate brachytherapy (HDR-BT) in all 4 (100%) of the studies that made this comparison and, overall, LDR-BT was the least costly of all active treatment options in 7 (50%) of the 14 studies.

Conclusion

The available health economic evidence suggests that LDR-BT has significant cost advantages and an important role to play in the delivery of value-based PCa care. In the future these advantages could be challenged if radiotherapy favours ultrahypofractionated strategies such as stereotactic body radiation therapy (SBRT) and reduced fractionation in HDR-BT.

中文翻译：

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低剂量率近距离放射治疗作为局部和局部晚期前列腺癌的主要治疗方法：经济评估的系统评价

背景

这项研究支持基于价值的前列腺癌 (PCa) 治疗方法，系统地回顾了经济评估，将低剂量率近距离放射治疗 (LDR-BT) 与其他局部治疗方案的成本和成本效益进行比较高级前列腺癌。

方法

在 MEDLINE、EMBASE 和塔夫茨医学中心的成本效益分析 (CEA) 注册表（Prospero 协议 CRD42023-442027）中检索了 2008 年至 2023 年间发表的研究。两名审稿人根据商定的纳入和排除标准独立筛选标题和摘要，然后进行全文筛选。Drummond 检查表用于严格评估纳入研究的质量。

结果

筛选 453 份记录后，检索了 36 份记录，纳入了 14 项符合条件的研究。其中，11 项比较了低风险和/或有利的中风险 PCa 的治疗方法，2 项比较了不利的中风险和/或高风险疾病的选择，1 项分析了两个风险组的治疗方法。所使用的人群、观点、时间范围、成本和结果数据存在相当大的异质性。如果标准治疗方法的肿瘤学结果被认为是相同的，则在 12 项研究中的 9 项（75%）中，LDR-BT 是最具成本效益的放射治疗 (RT) 类型，在 12 项研究中比根治性前列腺切除术 (RP) 更具成本效益9 项研究中的 6 项（67%），根据时间范围，5 项研究中的 3 项（60%）比主动监测 (AS) 更具成本效益。在进行此比较的所有 4 项研究（100%）中，LDR-BT 比高剂量率近距离放射治疗 (HDR-BT) 更具成本效益，总体而言，LDR-BT 是所有积极治疗方案中成本最低的在 14 项研究中的 7 项（50%）中。

结论

现有的健康经济证据表明，LDR-BT 具有显着的成本优势，并且在提供基于价值的 PCa 护理中发挥着重要作用。未来，如果放射治疗倾向于超低分割策略，例如立体定向全身放射治疗 (SBRT) 和 HDR-BT 中的减少分割，这些优势可能会受到挑战。