关键词：癌症筛检;成本效益;前列腺癌;决策理论;蒙特卡罗方法;放射治疗
摘 要：A Markov Monte Carlo model was constructed: adverse effects (AE) of treatment were included. Main outcomes were costs (2008US$), quality-adjusted life-years (QALYs), and incremental cost- effectiveness ratios (ICERs) for men 65, 55, and 75 years of age. In 65 year old men, AS was associated with the greatest QALE but at $35,201 was more expensive than brachytherapy(ICER $15,420/QALY); RP and IMRT were dominated. In 55 and 75 year old men these ICERs were $8,374/QALY and $8, 671/QALY, respectively. When costs of treatment of adverse effects were doubled, AS became least expensive in all men. When the PIVOT trial was simulated, WW was cost-saving compared with AS and RP and remained less expensive and associated with improved QALE over a wide range of cost and utilities, including if the risk of CaP-specific death on AS was 50the risk on WW. In this model, observation is a cost-effective alternative to initial treatment and is underutilized in these men.