Page 15 - CUA 2020_Endourology

Unmoderated Posters 1: Prostate Cancer, Endourology, BPH

UP-1.18. Table 4. Cox regression analysis of clinical UP-1.21
outcomes assessed Economic evaluation of robot-assisted radical prostatectomy
compared to open radical prostatectomy for prostate cancer
Time to biochemical recurrence treatment in Ontario, Canada
2,3
1
Effect Odds ratio (95% CI) Anna Parackal , Jean-Eric Tarride 1,2,3 , Feng Xie , Gord Blackhouse , Jen
1,2
2,4
4
5
4
Pre-treatment serum total testosterone 0.959 (0.774–1.130) Hoogenes , Paul Cheon , Daniell Hylton , Edward D. Matsumoto , Wael
4
5
6
(log-transformed) Hanna , Anthony Adili , Bobby Shayegan
Programs for Assessment of Technology in Health, McMaster University,
1
Age 1.009 (0.996–1.022) Hamilton, ON, Canada; Department of Health Research Methods,
2
Baseline PSA 1.022 (1.016–1.029) Evidence and Impact, McMaster University, Hamilton, ON, Canada;
3 Centre for Health Economics and Policy Analysis, McMaster University,
Clinical T stage 1.159 (1.040–1.292) Hamilton, ON, Canada; Department of Surgery, Division of Urology,
4
First positive biopsy Gleason score 1.523 (1.362–1.705) McMaster University, Hamilton, ON, Canada; Department of Surgery,
5
Time to radiation Division of Thoracic Surgery, McMaster University, Hamilton, ON,
6
Canada; Department of Surgery, Division of General Surgery, McMaster
Effect Odds ratio (95% CI)
University, Hamilton, ON, Canada
Pre-treatment serum total testosterone 0.925 (0.683–1.252) Introduction: Recent health technology assessments (HTAs) of robot-
(log-transformed) assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada,
Age 1.005 (0.987–1.023) resulted in opposite recommendations, calling into question whether ben-
efits of RARP offset the upfront investment. Therefore, the study objectives
Baseline PSA 0.986 (0.965–1.007) were to conduct a cost-utility analysis from a Canadian public payer
Clinical T stage 0.747 (0.600–0.931) perspective to determine the cost-effectiveness of RARP.
First positive biopsy Gleason score 1.204 (1.007–1.439) Methods: Using a 10-year time horizon, a five-state Markov model
was developed to compare RARP to open radical prostatectomy (ORP).
Time to androgen deprivation therapy Clinical parameters were derived from Canadian observational studies
Effect Odds ratio (95% CI) and a recently published systematic review. Costs, resource utilization,
Pre-treatment serum total testosterone 0.834 (0.571–1.218) and utility values from recent Canadian sources were used to popu-
(log-transformed) late the model. Results were presented in terms of increment costs per
quality-adjusted life years (QALYs) gained. A probabilistic analysis was
Age 1.004 (0.981–1.028) conducted, and uncertainty was represented using cost-effectiveness
Baseline PSA 1.019 (1.012–1.026) acceptability curves (CEACs). Deterministic sensitivity analyses were also
Clinical T stage 1.484 (1.283–1.715) conducted. Future costs and QALYs were discounted at 1.5%.
Results: Total costs of RARP and ORP were $57 925.44 and $55 524.18,
First positive biopsy Gleason score 2.076 (1.725–2.498) respectively. Total estimated QALYs were 7.180 and 7.114 for RARP and
Time to metastasis ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was
$36 564.69 in the base-case analysis. At a willingness-to-pay threshold
Effect Odds ratio (95% CI) of $50 000 and $100 000 per QALY gained, the probability of RARP
Pre-treatment serum total testosterone 0.781 (0.446–1.370) being cost-effective was 0.57 and 0.77, respectively. The model was most
(log-transformed) sensitive to the time horizon.
Age 1.020 (0.982–1.059) Conclusions: The results of this analysis suggest that RARP is likely to be
cost-effective in this Canadian patient population. The results are consis-
Baseline PSA 1.011 (0.998–1.024) tent with Alberta’s HTA recommendation and other economic evaluations,
Clinical T stage 1.609 (1.302–1.989) but challenges Ontario’s reimbursement decision.
First positive biopsy Gleason score 2.188 (1.661–2.882)
UP-1.22
Effects of omega-3 fatty acid supplements on perioperative blood
build predictive models based on conventional parameters (i.e., PSA, loss during radical prostatectomy
Gleason score) with or without quantitative, quartile, or decile % 4/5. 1 1 1
The Memorial Sloan Kettering Cancer Center (MSKCC) pre-prostatectomy Samuel Fradet , Karine Robitaille , Jean-François Pelletier , Louis
1,2
1,2
1,2
1,2
nomogram was used as a reference standard for our base model. We set Lacombe , Frédéric Pouliot , Paul Toren , Yves Fradet , Michele
2
1
1
2
2
sensitivity ≥0.80 and compared performance metrics for each outcome. Lodde , Rabi Tiguert , Thierry Dujardin , Josée Savard , Isabelle Bairati ,
3
1,2
Results: In all, 756 patients were included. Patient disease characteristics Narcisse Singbo , Vincent Fradet
1
were: 43.8% EPE, 2.3% RLNI, 11.5% SVI, 11.8% LVI, 33.6% PSM, and Oncology Unit, Centre de Recherche du CHU de Québec-Université
2
14.6% BCR. Our models compared favorably to the MSKCC nomogram Laval, Quebec City, QC, Canada; Centre de Recherche Clinique et
(Table 1). For SVI, inclusion of quartile and decile % 4/5 achieved areas Évaluative en Oncologie de L’Hôtel-Dieu de Québec, Quebec City,
3
under curve (AUC) of 0.811 and 0.829 vs. 0.779 for the MSKCC nomo- QC, Canada; Plateforme de Recherche Clinique et Évaluative, CHU de
gram (p=0.05 and 0.01, respectively). For BCR, the model, which included Québec-Université Laval, Quebec City, QC, Canada
decile % 4/5, outperformed the MSKCC nomogram with AUC 0.744 vs. Introduction: Many dietary supplements, including long-chain omega-3
0.711 (p=0.04). For all other outcomes, inclusion of % 4/5 to the base fatty acids (LCΩ3), are suspected to affect blood coagulation and platelet
model generally resulted in improvements across all performance metrics, function. Despite no clinical evidence, discontinuation is recommended
however, this did not reach statistical significance. before radical prostatectomy (RP). However, LCΩ3 could be beneficial
Conclusions: Our findings support the use of % 4/5, particularly quar- against prostate cancer progression. This study aims to determine the
tile and decile % 4/5, to improve predictions of adverse pathological effects of LCΩ3 supplements on perioperative bleeding, hemoglobin,
outcomes and BCR. These parameters may improve the performance of platelets, and postoperative complications at RP.
future iterations of widely used nomograms. Methods: This is a planned secondary analysis of all 130 patients diag-
nosed with prostate cancer grade group 2 or greater enrolled in a ran-
domized controlled trial (NCT02333435) testing the effects of LCΩ3,
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S53