Abstract
Purpose
Value, defined as outcomes over costs, has been proposed as a measure to evaluate
prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven
activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value
framework.
Methods and materials
Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were
included. Outcomes were recorded according to the International Consortium for Health
Outcomes Measurement standard set, which includes acute toxicity, patient-reported
outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after
PBT were collected using TDABC. Process mapping and radar chart analyses were conducted
to visualize this value framework.
Results
A total of 238 men were eligible for analysis. Median age was 64 (range, 46–81). Median
followup was 5 years (0.5–12.1). There were no acute Grade 3–5 complications. Expanded
Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant
changes from baseline to last followup at 48 months for urinary incontinence/bother,
bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including
biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific
survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource
utilization for PBT, with 41% and 10% of costs occurring in the operating room and
with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes
and costs.
Conclusions
We successfully created a visual framework to define the value of PBT using the International
Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated
with excellent outcomes and low costs. Widespread adoption of this methodology will
enable value comparisons across providers, institutions, and treatment modalities.
Keywords
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Article info
Publication history
Published online: February 23, 2016
Accepted:
January 19,
2016
Received in revised form:
January 18,
2016
Received:
December 9,
2015
Footnotes
Financial disclosure: This work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672).
Conflict of interest: SJF received an honorarium from and is a consultant for Varian Medical Systems and is a cofounder and director of C4 Imaging.
Identification
Copyright
© 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
