Cost-Effectiveness of Hydrogel Rectal Spacer in Radiotherapy for Prostate Cancer


A cost-effectiveness analysis presented at the 2018 Genitourinary Cancers Symposium (February 8-10, 2018; San Francisco, CA) examined the use of a hydrogel rectal spacer in patients with prostate cancer undergoing intensity-modulated radiation therapy.

The hydrogel rectal spacer—US Food and Drug Administration (FDA) approved device that increases the separation between the rectum and the prostate—has shown in a recent phase III trial the ability to produce a small reduction in the incidence of radiotherapy toxicities for patients with prostate cancer. However, the cost-effectiveness of this medical device  has yet to be determined.

Researchers from the University of Maryland School of Medicine conducted the first cost-effectiveness analysis of the hydrogel rectal spacer in patients receiving intensity-modulated radiation therapy for prostate cancer based on long-term toxicity data. Researchers utilized a multi-state Markov model to examine the cost-effectiveness among those receiving intensity modulated radiation therapy alone versus those receiving radiotherapy plus the medical device. Subgroup analysis included radiotherapy delivery site (hospital vs ambulatory) and baseline sexual function (general population vs those with good sexual function).

Health utilities and costs were extracted from the available literature and the 2018 Physician Fee Schedule. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of radiotherapy.

Researchers also conducted a probabilistic sensitivity analysis (PSA) and a value-based threshold analysis. Costs and utilities were discounted at 3% annually.


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Results of the study showed the per-person 5-year incremental cost for hydrogel rectal spacer administered in a hospital was $4,008 and the incremental effectiveness was 0.0273 QALYs. The incremental cost-effectiveness ratio (ICER) was $146,756 for patients undergoing hydrogel rectal spacer insertion in a hospital versus $73,359 for patients undergoing insertion in an ambulatory facility. Subgroup analysis showed for men with good sexual function, the ICER was $55,153 and $26,542 in those receiving insertion in a hospital and an ambulatory facility, respectively.

“Based on the current Medicare Physician Fee Schedule, the hydrogel rectal spacer is cost-effective in men with good sexual function at a willingness to pay threshold of $100,000 and it is marginally cost-effective for the entire population depending on the facility where it is inserted,” researchers concluded.—Zachary Bessette