OBJECTIVES: Focal therapy (FT) is considered an organ-sparing alternative to radical treatment in patients with localized prostate cancer (PC). Such therapies may result in better disease control at an acceptable cost. We aimed to assess the economic value of FT compared with traditional treatment in patients with PC.

METHODS: Embase^® and Medline^® were systematically searched via Embase.com (from database inception to May 2023) to identify relevant English-language publications reporting the economic value of FT in patients with PC. Searches were conducted in accordance with PRISMA guidelines. Electronic searches were supplemented by bibliographic searches; publications were screened by two independent reviewers.

RESULTS: Of the 109 records screened, three UK studies and one French study were included. Three studies conducted cost–utility analyses using Markov models, while one study conducted a cost–utility analysis and did not report model type. A UK NHS perspective was adopted in two studies and a French national health insurance perspective in one study; perspective was not reported in one study. In France, focal high intensity focused ultrasound (HIFU) was not cost-effective compared with active surveillance at a willingness-to-pay threshold of €30,000/QALY. In the UK, HIFU was cost-effective compared with external beam radiotherapy (EBRT) with an ICER of £2,915/QALY at a threshold of £30,000/QALY. However, EBRT dominated cryotherapy at the same threshold. In another study, cryotherapy did not demonstrate cost-effectiveness compared with traditional treatments, due in part to significant incidence of erectile dysfunction. For patients with recurrent PC following radiotherapy, cryotherapy was associated with lower cost and higher QALYs gained compared with androgen deprivation therapy.

CONCLUSIONS: Current evidence suggests limited cost-effectiveness of FT, owning to the higher cost compared with traditional treatments. However, the methods used were highly variable, making the comparison across studies difficult. Additional evidence is required to draw any definitive conclusions on economic value of FT.