Robot-Assisted Surgery vs Robotic Stereotactic Body Radiotherapy in Prostate Cancer: A Cost-Utility Analysis

Line Farah; Nicolas Magne; Nicolas Martelli; Sandrine Sotton; Marc Zerbib; Isabelle Borget; Nathaniel Scher; Thierry Guetta; Cyrus Chargari; Olivier Bauduceau; Alain Toledano

doi:10.3389/fonc.2022.834023

Robot-Assisted Surgery vs Robotic Stereotactic Body Radiotherapy in Prostate Cancer: A Cost-Utility Analysis

Front Oncol. 2022 May 24:12:834023. doi: 10.3389/fonc.2022.834023. eCollection 2022.

Authors

Line Farah^{1

2}, Nicolas Magne³, Nicolas Martelli^{1

4}, Sandrine Sotton³, Marc Zerbib⁵, Isabelle Borget^{1

6

7}, Nathaniel Scher⁸, Thierry Guetta⁹, Cyrus Chargari¹⁰, Olivier Bauduceau⁷, Alain Toledano⁷

Affiliations

¹ Groupe de Recherche et d'accueil en Droit et Economie de la Santé (GRADES) Department, Université Paris Saclay, Châtenay-Malabry, France.
² Department of the Innovation Center for Medical Devices, Innovation Center for Medical Devices (CiDM), Hôpital Foch, Suresnes, France.
³ Département de radiothérapie, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France.
⁴ Département de pharmacie , Hôpital Européen Georges Pompidou (HEGP), Paris, France.
⁵ Département d'urologie , Service d'urologie, Hôpital Cochin, Paris, France.
⁶ Département d'études en recherche et économie, Institut Gustave Roussy, Villejuif, France.
⁷ Département d'économie de la santé, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
⁸ Département de radiothérapie, Institut de radiothérapie et de radiochirurgie H. Hartmann, Paris, France.
⁹ Département d'urologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France.
¹⁰ Département d'oncologie en radiothérapie, Institut Gustave Roussy, Villejuif, France.

Abstract

Prostate cancer is the most common men cancer in France. Continuous progress in oncology led to develop robot-assisted Radical Prostatectomies (rRP) and robot-assisted stereotactic body radiotherapy (rSBRT). The present study aims at comparing economic and clinical impacts of prostate cancer treatments performed either with rSBRT or rRP in France. A Markov model using TreeAge Pro software was chosen to calculate annual costs; utilities and transition probabilities of localized prostate cancer treatments. Patients were eligible for radiotherapy or surgery and the therapeutic decision was a robot-assisted intervention. Over a 10-year period, rSBRT yielded a significantly higher number of quality-adjusted life years than rRP (8.37 vs 6.85). In France, rSBRT seemed more expensive than rRP (€19,475 vs €18,968, respectively). From a societal perspective, rRP was more cost-saving (incremental cost effectiveness ratio = €332/QALY). The model was sensitive to variations of costs of the initial and recurrence state in one-way sensitivity analyses. Robot-assisted stereotactic body radiotherapy seems more cost-effective than Radical Prostatectomy in terms of QALY despite the slightly higher initial cost due to the use of radiotherapy. It would be interesting to conduct comparative quality of life studies in France over longer periods of time.

Keywords: cost-utility analyses; health economic analysis; prostate cancer; quality of life; robot-assisted radical prostatectomy; stereotactic body radiation therapy (SBRT).