Cost-effectiveness analysis of Ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate-to-high-risk localized prostate cancer

Abstract Background: Radiotherapy is an effective curative treatment option for intermediate-to-high-risk localized prostate cancer. Given that no significant difference was observed in survival and toxicities, we evaluated the cost-effectiveness of ultra-hypofractionated radiotherapy and conventionally fractionated radiotherapy for intermediate-to-high-risk localized prostate cancer from the Chinese payer perspective. Methods: We developed a Markov model with a 15-year time horizon to compare the cost and effectiveness of ultra-hypofractionated radiotherapy with those of conventionally fractionated radiotherapy for localized intermediate-to-high-risk prostate cancer. Outcomes were measured in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and willingness-to-pay (WTP). Univariable and probability sensitivity analyses were performed to evaluate the robustness of the Markov model. Results: Based on the results of our Markov model, the conventionally fractionated radiotherapy yielded 2.32 QALYs compared with 2.14 QALYs in the ultra-hypofractionated radiotherapy in China. The cost of ultra-hypofractionated radiotherapy was found to be decreased by about 14% folds ($4251.04) in comparison to that of conventionally fractionated radiotherapy. The ICER of conventionally fractionated radiotherapy vs the ultra-hypofractionated radiotherapy was $23,616.89 per QALY in China. The most sensitive parameters were the ultra-hypofractionated radiotherapy utility of failure-free survival (FFS) with grade two or worse urinary toxicity and discount rate per annum. The cost effectiveness acceptability curve showed that conventionally fractionated radiotherapy had a 57.7% probability of being cost-effective at the Chinese WTP threshold. Conclusion: The ultra-hypofractionated radiotherapy was not a cost-effective strategy compared with conventionally fractionated radiotherapy in patients with localized intermediate-to-high-risk prostate cancer from the perspective of the Chinese payers. However, steep reductions in the grade two or worse urinary toxicity of the ultra-hypofractionated radiotherapy could alter the results.