Évaluation médico-économique du traitement par HIFU en thérapie focale comparé à une stratégie de surveillance active dans le cancer de la prostate localisé de risque faible à intermédiaire

Abstract : Introduction & objectives. Prostate cancer is the most frequently diagnosed cancer among men in the European Union with around 345,000 new cases estimated in 2012 representing 24 per cent of all new cancers diagnosed in the same year. The evolution of therapeutic strategies is major in recent years. Owing to informal and formal prostate-specific antigen screening practices, patients are diagnosed youngers and at low risk of disease progression which allows the use of active surveillance or more recent treatments like focal therapies. Focal high intensity focused ultrasound (HIFU) is a therapy directly curative, unlike active surveillance, and with less side effects than radical therapies. However focal HIFU is not covered by French Social Health Insurance. We hypothesize that focal HIFU could be more effective and despite significant initial costs less costly than active surveillance. Our objective was to evaluate the cost-effectiveness of focal HIFU compared to active surveillance in localized low- to intermediate-risk prostate cancers. Materials & methods. The medico-economic evaluation comparing focal HIFU to active surveillance was a cost-utility analysis from the French Social Health Insurance perspective, with a time horizon of 10 years and a 4% discount on costs and utilities. The analysis was performed using a Markov multi-state model supported by literature reviews and meta-analysis. Costs were extracted from a recent French cost study and using the French innovation fee for global HIFU. Utilities were extracted from an article measuring prostate cancer utilities with standard gamble revealing preferences method. We took into account uncertainty with deterministic and probabilistic sensitivity analyses. Results. We constructed a five health states model: initial state, radical prostatectomy, radiotherapy, metastasis and death. For a fictive cohort of 1000 people and at 10 years, focal HIFU was 207 520 € more expensive and led to a loss of 382 quality adjusted life years (QALY) compared to active surveillance. The corresponding incremental cost effectiveness ratio (ICER) was -544 €/QALY. For an ICER threshold of 30 000 €/QALY the probability of being cost-effective for HIFU focal compared to active surveillance was 40%. Conclusion. Our results suggest that focal HIFU is costlier and less effective than active surveillance in a situation of strong incertitude. This hypothesis must be confirmed by continuing to feed the model with active bibliography and, ideally, through the implementation of a medico-economic study enriched by Social Health Insurance data comparing active surveillance with focal HIFU.
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Master Thesis
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Submitted on : Thursday, November 2, 2017 - 6:25:03 PM
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Thomas Duroux. Évaluation médico-économique du traitement par HIFU en thérapie focale comparé à une stratégie de surveillance active dans le cancer de la prostate localisé de risque faible à intermédiaire. Médecine humaine et pathologie. 2017. ⟨dumas-01628042⟩

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