OBJECTIVES: Prostate cancer is the most common cancer among men in France. Continuous progress in oncology led to develop robot-assisted Radical Prostatectomies (rRP) with 30,000 robot-assisted procedures / year, and to improve radiotherapy with artificial intelligence (AI) based-robot-assisted stereotactic body radiotherapy (rSBRT). We aimed to compare economic and clinical impacts of prostate cancer treatments with rSBRT compared to rRP in France.

METHODS: Economic analysis comparing rRP and rSBRT through a Markov model to estimate cost-effectiveness with four states, using TreeAge Pro software and calculating annual costs; utilities and transition probabilities from our literature review, for patients with localized prostate cancer, eligible for radiotherapy or surgery, and for robot-assisted intervention with or without AI. Cost data was collected from multiple sources including the French Diagnosis Related Group system. Future costs were discounted at an annual rate of 4% as recommended by the French Health Agency.

RESULTS: Over a 10-year period, rSBRT yielded a significantly higher number of quality-adjusted life years than rRP (8.39 vs 7.74,). In France, rSBRT seems more expensive than rRP (€20,237 vs €18,158, respectively). From a societal perspective, rRP is cost saving when compared to rSBRT with an incremental cost effectiveness ratio of €3,124/QALY. Yet, the acceptability curve highlights that, over a 10-year period, artificial intelligence based-radiotherapy (rSBRT) becomes more cost-effective than robotic prostatectomy (rRP), beyond the €3,184 threshold. The model was sensitive to variations of costs of the initial state in one-way sensitivity analyses. Cost-effectiveness of rSBRT relative to rRP was robust to changes in variables in probabilistic sensitivity analyses.

CONCLUSIONS: Beyond the €3,184 threshold, AI based-radiotherapy seems cost-effective compared to robotic Prostatectomy, despite the slightly higher initial cost of the radiotherapy. It would be interesting to conduct comparative quality of life studies at an international level to validate the model overseas.