Cost-Effectiveness Analysis Comparing Conventional Versus Stereotactic Body Radiotherapy for Surgically Ineligible Stage I Non–Small-Cell Lung Cancer
| Autor: | Andrea Bezjak, Eric Gutierrez, Andrew Hope, A. Swaminath, Natasha B. Leighl, Meredith Giuliani, Terence Yung, Peter C. Coyte, Colleen Seereeram, Mark J. Dobrow, Gunita Mitera, David Rudoler |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Lung Neoplasms Stage I Non-Small Cell Lung Cancer Fractionated radiotherapy Cost-Benefit Analysis MEDLINE Carcinoma Non-Small-Cell Lung Carcinoma medicine Humans health care economics and organizations Aged Neoplasm Staging Aged 80 and over Oncology (nursing) business.industry Health Policy Dose fractionation Cost-effectiveness analysis Middle Aged medicine.disease Oncology Female Neoplasm staging Dose Fractionation Radiation business Nuclear medicine Stereotactic body radiotherapy |
| Zdroj: | Journal of Oncology Practice. 10:e130-e136 |
| ISSN: | 1935-469X 1554-7477 |
| DOI: | 10.1200/jop.2013.001206 |
| Popis: | In 25% to 35% of patients with early stage I non-small-cell lung cancer (NSCLC), surgery is not feasible, and external-beam radiation becomes their standard treatment. Conventionally fractionated radiotherapy (CFRT) is the traditional radiation treatment standard; however, stereotactic body radiotherapy (SBRT) is increasingly being adopted as an alternate radiation treatment. Our objective was to conduct a cost-effectiveness analysis, comparing SBRT with CFRT for stage I NSCLC in a public payer system.Consecutive patients were reviewed using 2010 Canadian dollars for direct medical costs from a public payer perspective. A subset of direct radiation treatment delivery costs, excluding physician billings and hospitalization, was also included. Health outcomes as life-years gained (LYGs) were computed using time-to-event methods. Sensitivity analyses identified critical factors influencing costs and benefits.From January 2002 to June 2010, 168 patients (CFRT, n = 50; SBRT, n = 118) were included; median follow-up was 24 months. Mean overall survival was 2.83 years (95% CI, 1.8 to 4.1) for CFRT and 3.86 years (95% CI, 3.2 to not reached) for SBRT (P = .06). Mean costs for CFRT were $6,886 overall and $5,989 for radiation treatment delivery only versus $8,042 and $6,962, respectively, for SBRT. Incremental costs (incremental cost-effectiveness ratio [ICER]) per LYG for SBRT versus CFRT were $1,120 for the public payer and $942 for radiation treatment alone. Varying survival and labor costs individually (± 20%) created the largest changes in the ICER, and simultaneous adjustment (± 5% to ± 30%) confirmed cost effectiveness of SBRT.Using a threshold of $50,000 per LYG, SBRT seems cost effective. Results require confirmation with randomized data. |
| Databáze: | OpenAIRE |
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