Main Findings Of Economic Evaluations Identified In The Systematic Reviews
Table shows the main findings of the cost effectiveness studies that compared IMRT with 3D-CRT.
Table 3 Main findings of Cost-effectiveness studies comparing IMRT and 3D-CRT for localized prostate cancer
Carter et al. found that IMRT was dominant strategy i.e. both more effective and less costly than 3DCRT over 20 years. After 20 years the model estimated a cost for IMRT is $32,816 and for 3D-CRT it was $33,917. The estimated QALYs for the IMRT and 3D-CRT were 10.079 and 10.060 respectively. This showed an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated over 20 years. The authors performed a one-way sensitivity analysis and showed that the model was highly robust to changes in individual parameters and IMRT remained the dominant treatment in all scenarios. For the probabilistic sensitivity analysis, the authors also showed that IMRT had an 86% probability of being dominant and a 93% probability of being a cost-effective treatment given an ICER threshold of $50,000 per QALY.
Table 4 Main findings of Cost-effectiveness studies comparing IMRT, SBRT and PBT for localized prostate cancer
What If I Have A Concession Card
Holding a Concession Card does not automatically mean that out of pocket costs will be lower. Please let the radiation therapy centre know that you have this as it helps them to understand your individual circumstances.
Holding a Concession Card reduces the level at which the Medicare Safety Net Threshold applies and provides extra support to reduce your out of pocket costs.
Many Treatment Options But Few Cost Analyses
Localized prostate cancer accounts for about 81 percent of the quarter-million cases of prostate cancers that occur in the United States every year, according to the National Cancer Institute. It is defined by tumors that have not metastasized and spread outside the prostate gland to other parts of the body.
There are multiple types of treatment for this form of the disease, including various types of surgery radiation therapy hormone therapies and combinations of each of these. Many men with low-risk prostate cancer do not need any of these treatments, and can be safely observed, at least initially.
Treatment plans for localized prostate cancer often vary dramatically from one treatment center to another. As Cooperberg put it, one person may have surgery, while someone across town with a very similar tumor may have radiation therapy, and a third may undergo active surveillance. All treatment regimens may do equally well.
There is very little solid evidence that one is better than another, said Cooperberg. The motivation for the new study, however, was that there are also few data examining the differences in terms of cost-effectiveness the price to the health care system for every year of life gained, with adjustment for complications and side effects of treatments.
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Economic Analysis Of Adjuvant Therapy With Radiotherapy
Konski et al. investigated the cost-effectiveness by means of a Markov model of the addition of total androgen suppression in men with locally advanced prostate cancer treated on Radiation Therapy Oncology Group trial 8610. This trial treated men with conformal radiotherapy with half receiving total androgen suppression consisting of 4 months of goserelin every 4 weeks and flutamide 2 months prior to and during the radiotherapy and the other half to radiotherapy alone. The analysis was from a payers perspective, i.e., Medicare. The ICER for the use of radiotherapy and total androgen suppression was well within the range of cost-effectiveness of $2,153/QALY with a > 80% probability of cost-effectiveness on the cost-effectiveness acceptability curve .
Neymark and colleagues performed an economic analysis of a very similar EORTC trial, EORTC 22863 which compared radiotherapy to radiotherapy plus adjuvant hormonal therapy. This study differed to the one published by Konski et al. in that the authors collected costs for the 90 patients randomized and treated at the Centre Hospitalier Universitaire of Grenoble, France. Resource use was abstracted from radiotherapy, urology and other hospital charts and the analysis performed from the French health insurance perspective. The addition of hormone therapy increased the mean survival time by about 1 year while reducing the cost per patient for the French health insurance by 12,700 FF .
Miscellaneous Economic Analyses Pertaining To Radiotherapy And Prostate Cancer
Rectal toxicity remains an important concern in the use of radiotherapy in the treatment of men with prostate cancer. The prostate is directly anterior to the rectum with the anterior rectal wall receiving the given dose of radiotherapy. Strategies have been developed to try and increase the distance between the anterior rectal wall and the prostate. The use of spacers made of hydrogel injected between the prostate and rectum has been developed in an attempt to increase the therapeutic ratio between normal tissue and the prostate. The use of these spacers has increased the incremental cost and has been evaluated in two cost-effectiveness analysis. Vanneste et al. used a Markov model investigating the use of spacers in the treatment of patients with prostate cancer over a 5-year time horizon. The age and stage of the base case was not specifically mentioned. The analysis was performed from the Netherland government perspective. Patients treated with a spacer had lower rectal toxicity when compared to men treated without the spacer. Treatment follow-up and toxicity costs where 160 less in men treated with the spacer incurred a higher cost of 1,700 for spacer placement. The ICER for spacer use was 55,880QALY which was below the 80,000/QALY threshold for cost-effectiveness in the Netherlands resulting in a 77% probability of cost effectiveness .
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Prostate Cancer Treatment Costs
One study found that the typical cost of treatment for a person with prostate cancer is about $2,800 per month after diagnosis. But these costs can be higher or lower, depending on if youâre insured or not, which type of insurance or government assistance you receive, and the specific kind of care you need. Costs can also vary in different parts of the country and by facilities.
You may already have an idea of some cancer care costs, but others might not be as obvious. You should consider:
Doctor visits. Your insurance might cover most of your appointment costs, but you may also have to cover a copay. This can vary, depending on your plan. In one study, the average copayment amount a month after a prostate cancer diagnosis was $37. That cost dropped to $31 a month 10 months after a diagnosis. If you have lab tests or radiology tests during your appointment, you might have to pay an extra cost as well. Talk to your doctor if youâre unable to pay fees or copays. They may be able to waive some of the charges or set up a payment schedule.
Medication. Like your doctor visits, you may have to cover a part of the cost of your medications. But there are many resources that can help lower these charges. Ask you doctor about the expected costs of your medications and if they recommend any resources to help with those expenses.
- Active surveillance
Are There Any New Techniques Devices Or Trials In The Field That You’re Enthusiastic About
There are new radiation methods some of which weve adopted and some of which are still being tested. We now use a therapy called volumetric modulated arc therapy. It shapes the rays to conform to the shape of a tumor this allows us to be precise and quick with treatment. In the field, there is also growing interest in the hypofractionated radiation technique for prostate cancer, which means that you deliver more radiation in a given treatment but over fewer sessions. There are trials going on to compare the safety and efficacy of this type of treatment compared with standard. treatment
We are actively exploring new technologies that may reduce radiation-related side effects, be they better ways to track and adjust for prostate motion, or ways to reduce the dose of radiation that is delivered to the rectum and bladder.
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Prostate Cancer: Costs Of Surveillance Surgery And Radiotherapy In The Nhs
The latest results from the Prostate Testing for Cancer and Treatment randomised controlled trial suggest radiotherapy is the most cost-effective treatment for localised prostate cancer.
The study compared the cost-effectiveness of active monitoring, surgery and radiotherapy from a UK NHS perspective at 10 years median follow-up.
The findings, reported in the British Journal of Cancer, show adjusted mean quality-adjusted life-years of 6.89 with active monitoring, 7.09 with radiotherapy and 6.91 with surgery.
Active monitoring had lower adjusted mean costs than radiotherapy and surgery .
Radiotherapy was the most likely cost-effective option at the UK National Institute for Clinical Excellence willingness-to-pay threshold of £20,000 per QALY.
Subgroup analyses confirmed radiotherapy was cost-effective for older men and intermediate/high-risk disease groups. Active monitoring was more likely to be the cost-effective option for younger men and low-risk groups.
Over the median 10-year period, the mean cost-difference between the radiotherapy and surgery groups was only £159.
This study is the first and only economic evaluation within a randomised trial comparing the three contemporary major treatment modalities.
The authors say longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a mans lifetime.
This article originally appeared on Univadis, part of the Medscape Professional Network.
Diarrhea Flatulence Or Painful Defecation
These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.
Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.
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Explaining The Costs Of Radiation Therapy In Australia
There are several cost factors that patients and their families need to think about when choosing the best treatment provider for them. These include direct costs such as those covered by Medicare, and other costs like travel, parking, accommodation and any allied health care that may be required.
To help answer some frequently asked questions, Targeting Cancer provides a handy factsheet which includes a list of questions patients should ask their radiation therapy provider about the costs of treatment.
In addition to covering the range of costs that patients should consider, the factsheet also explains the Medicare Safety Net, Medicare contributions and arrangements for concession card holders.
The factsheet includes a handy list of questions that patients can take with them to their radiation therapy centre to talk through these considerations. Most radiation therapy centres have dedicated accounts staff available to discuss cost considerations with patients and their families.
Brachytherapy Saves Va Funds
Radiation oncologist and McGuire VA physician Dr. Drew Moghanaki described the current financial climate of prostate cancer treatment :
The U.S. healthcare system is really a fee-for-service healthcare system. The more expensive procedures that can be done, the more revenue can be made. And brachytherapy just doesnt make a lot of money for, you know, practitioners out in the real world. When you put together the convenience of a one-day procedure that is more effective and more cost effective, it really is a win, win, win.
Seed implant is equally attractive to men who are self-insured or have large deductibles and/or co-payment requirements. Furthermore, with minimal side-effects and a short recovery period, brachytherapy allows men to return more quickly to their normal activities and work, a benefit to employers and productivity.
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Surgery For Prostate Cancer Treatment
Surgery is considered a first-line treatment for prostate cancer. Surgical removal of the prostate gland is recommended for patients with localized prostate cancer that does not have metastases. For more aggressive prostate cancer, surgery alone might not be enough.
There is an option of performing radical prostatectomy with a da Vinci robot. A tenfold imaging, highly detailed operating area, and microinstruments moving in any direction allow preserving the surrounding healthy tissues, avoiding blood loss, and minimizing the risks of urological problems or erectile dysfunction development.
Generally, surgery is aimed at preserving the erection nerves, and if possible, at preventing postoperative erectile dysfunction. Today, various surgical techniques are low-traumatic and allow sparing of the nerves responsible for erection.
All You Need To Know About Radiation Therapy
Radiation therapy, also known as radiotherapy, is a procedure in which ionizing radiation is used as a part of cancer treatment to inhibit or kill the malignant cells in the body.
How much does a Radiation Therapy cost in India?
The average cost of radiation therapy in India is usually between Rs.30,000 to Rs.20,00,000 depending on which type of radiation technique that is recommended. However, the prices may vary depending upon the hospitals in different cities.
What is the average cost of Radiation Therapy in Hyderabad?
The cost of radiation therapy in Hyderabad starts from Rs.1,90,000. Yet, it depends upon multiple factors.
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Brachytherapy: Cost Effective Successful Treatment Model
Brachytherapy, a minimally invasive procedure, provides excellent prostate cancer outcomes, is cost-effective and convenient, especially when compared to other treatment options. Radiation sources smaller than a grain of rice are placed inside the prostate, near cancer cells that are then disrupted and destroyed. At approximately 1/3 the cost of either surgical removal of the prostate or external beam radiation therapy, brachytherapy should serve as a model for other government sponsored healthcare programs, such as Medicare and Medicaid. Why would government sponsored programs pay more for treatments that do not provide better outcomes or fewer side effects?
Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
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Top Doctors Available In India For Prostate Cancer Treatment:
In India, most of the doctors who provide Prostate Cancer Treatment are well experienced and skilled Oncologists. They can diagnose the stage of cancer and can plan appropriate Prostate Cancer Treatment with minimal side effects. They work closely with the nursing staff to make sure the patient receives the correct dose of drugs and the highest quality of care.
These are the best doctors for Prostate Cancer Treatment in India:
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?