Clinical and Economic Implications of Cost-Effectiveness Data on ADT Strategies

In this segment, Amar U. Kishan, MD, of UCLA reflects on the economic and quality of life advantages of avoiding unnecessary androgen deprivation therapy (ADT) in clinical practice. He notes that even a short course of 4 to 6 months of ADT can impose a significant quality-of-life burden. For a patient who is ArteraAI-negative and therefore unlikely to benefit from ADT, that burden is incurred with no corresponding clinical gain, representing both a personal cost for the patient and an avoidable cost for the health care system.

In reflecting on the economic implications for health systems, Kishan addresses the objection that new biomarker tests inherently increase cost by adding a line item to the care pathway. He emphasizes findings from a cost-effectiveness analysis suggesting that the reduction in costs is associated with ADT administration and the downstream management of treatment-related adverse effects in patients who were never going to benefit from the therapy in the first place.

Kishan situates these findings within the broader transition toward value-based care models in oncology, arguing that cost-effectiveness research should become a standard component of how the field evaluates new diagnostics and therapeutics. He identifies patients with a favorable prognostic profile who are motivated to avoid hormone therapy as the population in which the ArteraAI test is likely to be most informative, while cautioning that the test should inform rather than replace clinical judgment, functioning as one input alongside other biomarkers, patient preferences, and physician assessment in a holistic treatment decision.