Economic evaluation of screening and treatment for prostate cancer in the Midland Cancer Network region in New Zealand

Abstract

Background: Prostate cancer is the most frequently diagnosed cancer and the third most common cause of cancer death for men in New Zealand. Aim: This thesis aims to use economic approaches to examine the screening and treatment pathway for prostate cancer in the Midland Cancer Network Region. Methods: This thesis comprises two systematic reviews, and five original studies: 1) the costs of identifying a new case of prostate cancer by screening; 2) survival in a cohort of men with prostate cancer; 3) the cost-effectiveness of active surveillance compared to radical prostatectomy for low risk localised prostate cancer; 4) the cost-effectiveness of active surveillance for intermediate risk prostate cancer; 5) the management and costs of metastatic prostate cancer. Results: The screening costs per cancer detected in New Zealand were NZ$10,777, and varied by subgroups. For men diagnosed with low risk localised prostate cancer at the age of 45-55 years, the life-time costs of active surveillance were higher than the costs of radical prostatectomy. For men diagnosed with low risk or intermediate risk prostate cancer at the age of 60-70 years, the life-time costs of active surveillance were lower than the costs of radical prostatectomy. The cost-effectiveness of active surveillance compared to radical prostatectomy depends on the quality of life under these treatments and the annual probability of having radical prostatectomy in the active surveillance arm. The daily prostate cancer related costs for men with metastatic prostate were highest during the terminal phase (NZ$57) and lowest during the treatment phase (NZ$18). Conclusions: General practice screening costs for prostate cancer could be reduced by better targeting. In terms of the life-time treatment costs, active surveillance is a reasonable option for men diagnosed with low risk or intermediate risk localised prostate cancer at the age of 60-70 years. If active surveillance is to be recommended, better evidence is needed to support of improved quality of life. On current evidence, radical prostatectomy in younger men seems more likely to be cost-effective. The management costs for patients with metastatic prostate cancer varied by phase, with terminal phase being the most expensive.