{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T01:40:24Z","timestamp":1776217224270,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Contemporary methods of external beam radiotherapy for prostate cancer have reduced toxicity rates through beam modulation and image guidance, however, rectal injury has not been eliminated completely in this population. For patients at greatest risk of developing rectal toxicities, hydrogel spacers are a viable option for risk reduction. Translation of clinical trial results into routine clinical practice relies on an understanding of the economic implications. This study completed a cost\u2010effectiveness analysis of hydrogel spacers in the Australian healthcare setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Simulation of possible health states following treatment was performed using a Markov model. Model outcomes included the incremental cost\u2010effectiveness ratio and the net monetary benefit (NMB) at three published willingness\u2010to\u2010pay thresholds derived from literature. Probabilistic sensitivity analyses were provided on these results. A baseline cohort without hydrogel spacer use was compared to treat all and selective use cohorts. Cost variation scenarios were also investigated to assess the impact of hydrogel spacer cost on outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using hydrogel spacers in a selective cohort was more likely to be cost\u2010effective than giving to all patients (NMB \u2212$43 versus \u2212$997, respectively); however, the incremental cost\u2010effectiveness ratio was not below the $28\u2009000 willingness\u2010to\u2010pay threshold for a healthcare provider perspective. These outcomes were influenced by large parameter uncertainty. Cost variation strategies are worth investigating further as a method to achieve willingness\u2010to\u2010pay threshold targets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The influence of parameter uncertainty currently limits the cost\u2010effectiveness of this intervention in the Australian public health setting. However, a cost variation solution has been demonstrated to improve cost\u2010effectiveness estimates for selected patients and should be examined further.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1754-9485.13311","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T09:15:05Z","timestamp":1629105305000},"page":"931-939","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cost\u2010effectiveness analysis of hydrogel spacer for rectal toxicity reduction in prostate external beam radiotherapy"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8310-6393","authenticated-orcid":false,"given":"Scott","family":"Jones","sequence":"first","affiliation":[{"name":"Radiation Oncology Princess Alexandra Hospital, Raymond Terrace Brisbane Queensland Australia"},{"name":"Science and Engineering Faculty Queensland University of Technology Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"White","sequence":"additional","affiliation":[{"name":"Australian Centre for Health Services Innovation and Centre for Healthcare Transformation School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Holt","sequence":"additional","affiliation":[{"name":"Radiation Oncology Princess Alexandra Hospital, Raymond Terrace Brisbane Queensland Australia"},{"name":"University of Queensland Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Graves","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2017.06.035"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.1652"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2016.12.015"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606221"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.08.074"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-015-0025-6"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2017.11.016"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15097"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.01.005"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2016.02.024"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2018.10.003"},{"key":"e_1_2_8_13_1","volume-title":"Hydrogel spacers in external beam radiation therapy of prostate cancer: Patient selection and cost\u2010effectiveness","author":"Jones SG","year":"2020"},{"key":"e_1_2_8_14_1","unstructured":"(TROG) TROG.The Assessment of New Radiation Oncology Technologies and Treatments (ANROTAT) Project Final Report 2012."},{"key":"e_1_2_8_15_1","unstructured":"Medical Services Advisory Committee. Technical Guidelines for preparing assessment reports for the Medical Services Advisory Committee \u2013 Medical Service Type: Therapeutic Australian Government Department of Health 2.0 ed: 2016."},{"key":"e_1_2_8_16_1","author":"United States Department of Health","year":"2013","journal-title":"National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2019.0431"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2018-229143"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/iju5.12209"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.77.9868"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/pcan.2009.56"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.05.007"},{"key":"e_1_2_8_23_1","unstructured":"Filipovi\u0107\u2010PierucciA ZarcaK&Durand\u2010ZaleskiIMarkov Models for Health Economic Evaluations: The R Package heemod. ArXiv e\u2010prints. R package version 0.14.2. 2017."},{"key":"e_1_2_8_24_1","series-title":"R Foundation for Statistical Computing","volume-title":"R: A language and environment for statistical computing","year":"2018"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.14044"},{"key":"e_1_2_8_26_1","unstructured":"Australian Government DoHMBS Online 2019;http:\/\/www.mbsonline.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/Home.Accessed 11\/6\/2019."},{"key":"e_1_2_8_27_1","unstructured":"Government A.The Pharmaceutical Benefits Advisory Committee Guidelines. In: Health Do ed2016."},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-017-0585-2"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2018.06.009"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.07.026"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000156862.33341.45"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0219-x"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2017.07.008"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.12.024"}],"container-title":["Journal of Medical Imaging and Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.13311","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1754-9485.13311","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.13311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T11:43:42Z","timestamp":1693223022000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1754-9485.13311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,16]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1111\/1754-9485.13311"],"URL":"https:\/\/doi.org\/10.1111\/1754-9485.13311","archive":["Portico"],"relation":{},"ISSN":["1754-9477","1754-9485"],"issn-type":[{"value":"1754-9477","type":"print"},{"value":"1754-9485","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,16]]},"assertion":[{"value":"2021-05-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}