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Low-dose-rate brachytherapy as a primary treatment for localised and locally advanced prostate cancer: a systematic review of economic evaluations

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

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.

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Acknowledgements

We thank Beata Coffey (BC), Information Specialist at the Royal Society of Medicine, for her assistance in developing a search strategy and performing the literature search. We also thank Alka Singh (AS), Associate Consultant at Mtech Access, and Jodie Worrall (JW), Associate Director at Mtech Access, who in their capacity as second reviewers independently screened reports, assessed them for eligibility and helped select reports for inclusion by consensus with the authors.

Funding

The study was funded by Becton, Dickinson and Company but they took no part in the design of the study, the collection and analysis of data, the preparation of the manuscript or the decision to publish.

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Authors and Affiliations

  1. Institute of Healthcare Leadership and Management, Oxford, UK

    Benedict Stanberry

  2. Becton, Dickinson and Company, Winnersh, UK

    Nikki Webber-Jones

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Benedict Stanberry (BS) jointly conceived the design of the study with Nikki Webber-Jones (NWJ). BS then developed and submitted the protocol. Together with BC he jointly developed the search strategy and BC performed the literature search. BS, AS and JW independently screened reports, assessed them for eligibility and selected reports for inclusion by consensus. BS wrote the manuscript and NWJ critically reviewed it.

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Correspondence to Benedict Stanberry.

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BS declares that he has received compensation from Becton, Dickinson and Company for participating in conferences and workshops. NWJ works for Becton, Dickinson and Company.

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Stanberry, B., Webber-Jones, N. Low-dose-rate brachytherapy as a primary treatment for localised and locally advanced prostate cancer: a systematic review of economic evaluations. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00817-z

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