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Int J Radiat Oncol Biol Phys. 2015 Feb 1;91(2):277-87. doi: 10.1016/j.ijrobp.2014.09.044. Epub 2014 Dec 6.

Estimating preferences for treatments in patients with localized prostate cancer.

Author information

1
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain.
2
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
3
Servicio de Oncología Radioterápica, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.
4
Servicio de Urología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
5
Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián, Spain.
6
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès, Spain.
7
Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain.
8
Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain.
9
Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain.
10
Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain.
11
Servicio de Urología, Fundació Puigvert, Barcelona, Spain.
12
Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
13
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
14
Epidemiology and Evaluation Research Group, Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
15
Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain. Electronic address: mferrer@imim.es.

Abstract

PURPOSE:

Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects.

METHODS AND MATERIALS:

This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias.

RESULTS:

Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects.

CONCLUSIONS:

Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.

PMID:
25491504
DOI:
10.1016/j.ijrobp.2014.09.044
[Indexed for MEDLINE]

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