A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases

Mehta, Minesh P.; Noyes, William; Craig, Bruce; Lamond, John P.; Auchter, Richard M.; French, Molly; Johnson, Mark D.; Levin, Allan B.; Badie, Behnam; Robbins, Ian; Kinsella, Timothy J.

doi:10.1016/s0360-3016(97)00071-0

Cited by 178 publications

(62 citation statements)

References 14 publications

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“…However, our results are similar to Mehta and colleagues. 13 They used their local hospital's cost-accounting system to generate costs -the cost of whole brain radiation was $6,500 and the cost of whole brain radiation plus radiosurgery was $15,102 (US$).…”

Section: Discussionmentioning

confidence: 99%

The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

Sharieff¹,

Whitton²,

Chow³

et al. 2013

Can. J. Neurol. Sci.

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Brain metastases occur in up to 40% of patients with cancer.1,2 Randomized trials have demonstrated improved survival and quality of life when radiosurgery is added to conventional whole brain radiation therapy (WBRT). 3 Radiosurgery has thus become the standard of care in conjunction with WBRT for the treatment of brain metastases. Currently, its largest use is in the treatment of brain metastases. 4 Radiosurgery can be delivered by either modifying an existing linear accelerator 'fixed-gantry' system (which can also deliver 'other' radiotherapy treatments), or by acquiring a dedicated radiosurgery unit, such as a 'robotic' system. 5 Both methods produce accuracy to within 1 mm of target volume, and thus both are deemed equally effective and equally safe. [6][7][8] However, community need, costs, patient preferences and budget constraints are important considerations in decisionmaking. We performed an economic evaluation of robotic radiosurgery for brain metastases in comparison to fixed gantry radiosurgery in order to help guide decision makers. ABSTRACT:Background: Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry linacbased systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other. Methods: Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient. Results: The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting). Conclusion: in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery.RÉSUMÉ: Technique utilisée et coût de la radiochirurgie pour le traitement de 1 à 3 métastases cérébrales. Contexte : la radiochirurgie peut être administrée au moyen de différentes modalités dont les systèmes robotisés et de type liNAC à portique fixe. Ces modalités de traitement semblent être également efficaces et sûres. le choix de l'une ou l'autre semble déterminé par les besoins de la communauté et les coûts. Nous avons effectué une évaluation économique pour identifier le contexte dans lequel l'une pourrait être préférée à l'autre. Méthode : Nous avons calculé ce que coûterait par patient la radioch...

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Section: Discussionmentioning

confidence: 99%

The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

Sharieff¹,

Whitton²,

Chow³

et al. 2013

Can. J. Neurol. Sci.

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“…Mehta et al previously reported that SRS was significantly less expensive than surgical intervention per week of survival ($270 per week vs $524 per week). 17 Rutigliano and colleagues similarly compared SRS with resection of single brain metastasis and observed that, even if all surgical resection morbidity was excluded from the comparison, SRS was still more cost-effective. 18 Vuong et al performed a similar comparison from the perspective of Germany's statutory health insurance system and observed that SRS was more costeffective per year of life saved, which was attributed to a decreased cost for SRS versus resection and an increased in survival for those who underwent SRS (18.4 months vs 13.0 months).…”

Section: Economic Impact Of Surveillancementioning

confidence: 99%

Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

Lester

Taksler

Kuremsky

et al. 2013

Cancer

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BACKGROUND:Insurers have started to deny reimbursement for routine brain surveillance with magnetic resonance imaging (MRI) after stereotactic radiosurgery (SRS) for brain metastases in favor of symptom-prompted imaging. The authors investigated the clinical and economic impact of symptomatic versus asymptomatic metastases and related these findings to the use of routine brain surveillance. METHODS: Between January 2000 and December 2010, 442 patients underwent upfront SRS for brain metastases. In total, 127 asymptomatic patients and 315 symptomatic patients were included. Medical records were used to determine the presenting symptoms, distant and local brain failure, retreatment, and need for hospital and rehabilitative care. Cost-of-care estimates were based on Medicare payment rates as of January 2013. RESULTS: Symptomatic patients had an increased hazard for all-cause mortality (hazard ratio, 1.448) and were more likely to experience neurologic death (42% vs 20%; P <.0001). Relative to asymptomatic patients, symptomatic patients required more craniotomies (43% vs 5%; P <.0001), had more prolonged hospitalization (2 vs 0 days; P <.0001), were more likely to have Radiation Therapy Oncology Group grade 3 and 4 post-treatment symptoms (24% vs 5%; P <.0001), and required $11,957 more on average to manage per patient. Accounting for all-cause mortality rates and the probability of diagnosis at each follow-up period, the authors estimated that insurers would save an average $1326 per patient by covering routine surveillance MRI after SRS to detect asymptomatic metastases. CONCLUSIONS: Patients who presented with symptomatic brain metastases had worse clinical outcomes and cost more to manage than asymptomatic patients. The current findings argue that routine brain surveillance after radiosurgery has clinical benefits and reduces the cost of care. Cancer 2014;120:433-41.

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“…14,15 Additionally, up to 40% of patients with brain metastasis will present with a single lesion. 15,16 It is estimated that there are approximately 60,000 new cases of cancer per year in Ontario, resulting in up to 12,000 patients per year presenting with a single brain metastasis. 10 Approximately 50% of these patients will require an operative procedure for emergent symptom resolution or tissue diagnosis, leaving 6,000 patients in Ontario every year for the elective management of a single brain metastasis from any primary tumor site.…”

Section: Analytic Approach To Radiosurgery Planning For Brain Metastasesmentioning

confidence: 99%

“…10 Approximately 50% of these patients will require an operative procedure for emergent symptom resolution or tissue diagnosis, leaving 6,000 patients in Ontario every year for the elective management of a single brain metastasis from any primary tumor site. 10,16,17 With the current size of the population at 13.0 million, there are 6,000 potential candidates for radiosurgery for a single brain metastasis, or 0.05% of the population. If one had access to high-quality local data regarding the incidence of urgent and elective presentations of single brain metastases, one could substitute local data to calculate this percentage.…”

Section: Analytic Approach To Radiosurgery Planning For Brain Metastasesmentioning

confidence: 99%

Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario

Greenspoon

O’Reilly²,

Wright³

et al. 2012

JOP

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Purpose: With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to allocate capital radiotherapy resources to meet both current and future radiosurgery requirements. The goal of this article is to demonstrate the feasibility of applying an explicit, needs-based model to resource planning in radiation oncology. Methods:Using an analytic model that relates radiosurgery need to population size, epidemiology, level of service planned, and productivity, the current radiosurgical need for single brain metastases in Ontario was estimated. The model was populated using Ontario-specific data where possible and supplemented with information from the published literature. Multiway sensitivity analyses were performed to calculate the minimum and maximum technology requirements. Results:The calculated number of full-time radiosurgical units required to treat patients with single brain metastases in Ontario was 5.9. Sensitivity analyses performed varying both level of service planned and productivity yielded a range of requirements from 2.5 to 12.2 full-time radiosurgery units. Conclusion:We have shown through the example of single brain metastases in Ontario that it is feasible to perform explicit, needs-based resource planning in radiation oncology. As the availability of new specialized technology increases, health care decision makers may use this approach to ensure the needs of their population are met while maximizing productivity and minimizing opportunity cost.

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A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases

Cited by 178 publications

References 14 publications

The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario

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