EURURO Vol. 72 No. 5

712 860

Platinum Priority – Review – Prostate Cancer
Editorial by Timothy J. Wilt and Philipp Dahm on pp. 736–737 of this issue
Cost of New Technologies in Prostate Cancer Treatment:
Systematic Review of Costs and Cost Effectiveness of
Robotic-assisted Laparoscopic Prostatectomy,
Intensity-modulated Radiotherapy, and Proton Beam Therapy
Florian Rudolf Schroeck Bruce L. Jacobs , Sam B. Bhayani Paul L. Nguyen
David Penson Jim Hu
a White River Junction VA Medical Center, White River Junction, VT, USA; bSection of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical
Center, Lebanon, NH, USA; c The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH,
USA; dDepartment of Urology, University of Pittsburgh, Pittsburgh, PA, USA; e Center for Research on Health Care, Division of General Internal Medicine,
University of Pittsburgh, Pittsburgh, PA, USA; f Division of Urology, Washington University School of Medicine, St Louis, MO, USA; g Department of Radiation
Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA; hDepartment of Urologic Surgery, Vanderbilt
University, Nashville, TN, USA; i
[2_TD$DIFF]VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA; j Department of
Urology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
available at
journal homepage:
Article info
Article history:
Accepted March 17, 2017
Associate Editor:
Giacomo Novara
Keywords:
Prostate cancer
New technology
Cost
Cost effectiveness
Systematic review
Abstract
Context: Some of the high costs of robot-assisted radical prostatectomy (RARP), inten-
sity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better
outcomes or less resource use during the treatment episode.
Objective: To systematically review the literature to identify the key economic trade-
offs implicit in a particular treatment choice for prostate cancer.
Evidence acquisition: We systematically reviewed the literature according to the Pre-
ferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement
and protocol. We searched Medline, Embase, and Web of Science for articles published
between January 2001 and July 2016, which compared the treatment costs of RARP,
IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and
three studies, respectively.
Evidence synthesis: RARP is costlier than radical retropubic prostatectomy for hospitals
and payers. However, RARP has the potential for a moderate cost advantage for payers
and society over a longer time horizon when optimal cancer and quality-of-life out-
comes are achieved. IMRT is more expensive from a payer’s perspective compared with
three-dimensional conformal radiotherapy, but also more cost effective when defined by
an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton
beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the
limited comparative data on outcomes. Using the Grades of Recommendation, Assess-
ment, Development and Evaluation approach, the quality of evidence was low for RARP
and IMRT, and very low for proton beam therapy.
Conclusions: Treatment with new versus traditional technologies is costlier. However,
given the low quality of evidence and the inconsistencies across studies, the precise
y Florian R. Schroeck and Bruce L. Jacobs contributed equally to this work.
* Corresponding author. VA Outcomes Group, WRJ VA Medical Center, 215NMain Street, White River
Junction, VT 05009, USA. Tel. +1 802 295 9363x6565.
E-mail address: (F.R. Schroeck).
0302-2838/Published by Elsevier B.V. on behalf of European Association of Urology.