Cost-Effectiveness Analysis of IMRT versus 3DCRT for Preoperative Treatment of Extremity Soft Tissue Sarcomas

Publication date: Available online 6 February 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Patrick Richard, Mark Phillips, Wade Smith, Darin Davidson, Edward Kim, Gabrielle Kane
PurposeCreate a cost-effectiveness model comparing preoperative intensity-modulated radiation versus 3D conformal radiation for extremity soft tissue sarcomas.Methods and MaterialsInput parameters included 5-year local recurrence rates, acute wound complication rates, and chronic toxicities (edema, fracture, joint stiffness, and fibrosis). Health-state utilities were used to calculate quality-adjusted life years (QALYs). Overall treatment costs per QALY or incremental cost-effectiveness ratio (ICER) were calculated. Roll-back analysis was performed using average costs and utilities to determine the baseline preferred radiation technique. One-way, two-way, and probabilistic sensitivity analyses (PSA) were performed for input parameters with the largest impact on the ICER.ResultsOverall treatment costs were $17,515.58 for 3DCRT compared to $22,920.51 for IMRT. The effectiveness was higher for IMRT (3.68 QALYs) compared to 3DCRT (3.35 QALYs). The baseline ICER for IMRT was $16,842.75/QALY, making it the preferable treatment. The ICER was most sensitive to the probability of local recurrence, upfront radiation costs, local recurrence costs, certain utilities (no toxicity/no recurrence, grade 1 toxicity/no local recurrence, grade 4 toxicity/no local recurrence), and life expectancy. Dominance patterns emerged when the cost of 3DCRT exceeded $15,532.05 (IMRT dominates) or the life expectancy was under 1.68 years (3DCRT dominates). Furthermore, preference patterns changed based on the rate of local recurrence (threshold: 13%). PSA results demonstrated that IMRT was the preferred cost-effective technique for 64% of trials compared to 36% for 3DCRT.ConclusionsBased on our model, IMRT is the preferred technique by lowering rates of local recurrence, severe toxicities, and improving QALYs. From a third party payer perspective, IMRT should be a supported approach for extremity soft tissue sarcomas.

Teaser

Both IMRT and 3DCRT remain options for the preoperative management of soft-tissue sarcomas. Although IMRT is more costly, our analysis has shown its cost-effectiveness compared to 3DCRT through reducing rates of severe toxicities/local recurrences and improving quality-adjusted life years. Furthermore, IMRT was the preferred technique in 64% of probabilistic sensitivity analyses trials. Third-party payers should support IMRT as a cost-effective option for the pre-operative management of soft-tissue sarcomas.


from Cancer via ola Kala on Inoreader http://ift.tt/1XbKo8U
via IFTTT