Nataniel Lester-Coll, M.D., Lead Author of JAMA Open Network Publication

The United States’ 2016 passage of the Affordable Care Act initiated a health care shift to a value-based system focused on managing costs while improving outcomes, and rewarding prevention and long-term positive patient outcomes. Applying this new focus to cancer treatment, an interdisciplinary team of Vermont researchers and a partner at Yale's Smilow Cancer Center, conducted an economic evaluation to establish an overall cost-effectiveness comparison of two approaches to the treatment of low-volume metastatic prostate cancer. Their findings, published in JAMA Network Open, strongly support the addition of prostate radiation therapy (PRT) to standard androgen deprivation therapy (ADT).

The use of PRT in prostate cancer patients with low metastatic burden was recently accepted as a new standard of care with results from the STAMPEDE-H clinical trial. Clinical and epidemiological researchers at the University of Vermont (UVM) Cancer Center, along with health services researchers at the UVM Larner College of Medicine, set out to test the overall cost-effectiveness of this new treatment approach to more empirically establish and inform a nationwide approach to treating the large number of patients in this country diagnosed with prostate cancer each year, with prostate cancer accounting for 1 in 5 new cancer diagnoses among men annually in the United States, according to the American Cancer Society’s 2020 Cancer Statistics Report.

Outcomes measured by the team included net quality-adjusted life-years (QALYs), costs in U.S. dollars, and incremental cost-effectiveness ratios comparing the use of prostate radiation therapy (PRT) as a supplement to androgen deprivation therapy (ADT), versus ADT alone, in newly diagnosed, low-volume metastatic prostate cancer patients. The study, utilizing data from a simulated cohort of 10,000 patients, supports the addition of PRT therapy for both cost and overall quality of life for patients. This result was robust and persisted despite testing many assumptions regarding rates of cancer progression, side effects, and costs of treatments. 

"The present evidence supports delivering radiotherapy to the primary tumor in men with low-burden metastatic prostate cancer," said lead author Nataniel Lester-Coll, M.D., UVM assistant professor and radiation oncologist at the UVM Cancer Center. "Our economic analysis found that prostate radiotherapy reduced overall treatment-associated payer costs, while improving quality-adjusted survival in patients."

The study’s aim is to help providers, payers and patients approach the clinical treatment of low-dose metastatic prostate cancer with a common understanding of the value to both individual patients and our health system. In addition, the data informs future clinical trials for prostate cancer to increase the value of novel cancer treatments.