Comparing the costs of three prostate cancer follow-up strategies: A cost-minimisation analysis (iHEA)

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Publication date: 
July, 2015
Presentation type: 
Oral presentation
Related staff: 
Dr Alison Pearce (former staff)
Dr Aileen Timmons (former staff)
Dr Frances Drummond (former staff)
Prof Linda Sharp (former staff)

Introduction: Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors means this model of care may not be economically sustainable, and a number of alternative approaches have been suggested.

Objectives: The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland – the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice defined using results of a survey of health professionals in Ireland.

Methods: A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for a cohort of 1000 men aged 66 with prostate cancer treated with curative intent. Transition probabilities were taken from EQ-5D-5L scores from two cross-sectional surveys of prostate cancer survivors in Ireland, published rates of biochemical relapse, and Irish life tables. The model took a healthcare payer’s perspective over a 10 year time horizon with discounting at 5% per annum.

One-way sensitivity analyses assessed the impact of altering the definition of a physical or psychosocial problem requiring treatment, altering medical card eligibility, scaling costs to the Irish setting and the discount rate. In addition, probabilistic sensitivity analysis was conducted to explore the impact on the cost estimates of varying all of the probability parameters and the cost of a PSA test simultaneously.

Results: Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74% of current practice costs) and the EAU guidelines intermediate (92% of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish healthcare system could have saved €842,000 over a 10 year period if the NICE guidelines were adopted.

Although the sensitivity analyses altered the magnitude of the cost of follow-up per survivor for each alternative, none resulted in a change of decision that current practice was the least cost-efficient option. The current practice arm was most sensitive to changing the proportion of primary care visits paid for by the healthcare system, while the NICE guideline was most sensitive to altering the percentage of patients assumed to have a physical or psychosocial problem requiring treatment.

Conclusions: This is the first study investigating costs of prostate cancer follow-up in the Irish setting.  These results suggest potential for significant savings within the Irish healthcare system associated with implementation of alternative models of prostate cancer follow-up care, in particular the increasing involvement of general practice. 

Published abstract: 
Pearce AM, Ryan F, Thomas AA, Timmons A, Drummond FJ, Sharp L
Pearce A
Conference/meeting title: 
2015 International Health Economics Association Congress
Event date: 
12 Jul 2015 to 15 Jul 2015
Milan, Italy

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