Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients

Abstract

Background: Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform costeffectiveness analyses of standard of care (SOC) and advanced PMRT techniques including intensity-modulated radiotherapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT (MA-VMAT), Tomotherapy (TOMO), mixed beam therapy (MIXED), and intensity-modulated proton therapy (IMPT). Methods: Using a Markov model, we estimated the cost-effectiveness of various techniques over 15 years. A cohort of women (55-year-old) was simulated in the model, and radiogenic side effects were considered. Transition probabilities, utilities, and costs for each health state were obtained from literature and Medicare data. Model outcomes include quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER).

Cost-effectiveness of Post-Mastectomy Radiotherapy (PMRT) for breast cancer in India: An economic modelling study

“…These findings are like other studies which demonstrate a QALY gain ranging from 0.19 to 0.76. 10 , 12 , 13 , 39 In terms of ICER, our findings are consistent with other studies in different settings. Wan et al reports that PMRT for patients with 1–3 node involvement is cost-effective in China, however, uncertainty of PMRT being cost-effective are relatively greater for patients with pN4+.…”

“… 12 Xie and colleagues report that PMRT with advanced techniques like IMRT are cost-effective at a willingness to pay of $100,000, however, none of the advanced radiotherapy techniques are cost-effective at $50,000. 13 Similar to findings of this study, our model also reports that IMRT is not cost-effective at our threshold of USD 1962.…”

“… 9 , 10 , 11 , 12 A recent model-based analysis compared the newer radiation techniques for incidence of late toxicities, however, the authors did not account for variation in nodal status as well as the laterality of breast involved. 13 Most importantly, all these studies represent high or upper middle income countries and thus there is a need to generate such evidence for low-and-middle income countries like India as well. In the present analysis, we evaluate the cost-effectiveness of PMRT based on the type of radiation technique, i.e., 2-dimensional radiotherapy (2-DRT), 3D-CRT and IMRT; extent of lymph node involvement; incidence of late radiation hazards; left or right sided tumours; and finally evaluated the scenarios of standard fractionation and hypofractionation for all the possible combinations.…”

Cost-effectiveness analysis of radiotherapy techniques for whole breast irradiation

“…Advanced radiotherapy techniques could avoid high dose expose to surrounding and underlying healthy tissues and improve the quality of life for the patients. A previous study from our group evaluated cost-effectiveness of current SOC post-mastectomy radiotherapy (PMRT) and seven advanced PMRT techniques over 15 years [54]. It used a similar Markov model and showed that the model outcomes are most sensitive to the probability of developing cardiac toxicity for PMRT patients.…”

Proton beam therapy for children and adolescents and young adults (AYAs): JASTRO and JSPHO Guidelines

“…Therefore, long-term follow-up in clinical practice is necessary to assess the effect of PBT on decreasing onset of second cancer. SR-3: Cost-effectiveness of proton beam therapy [28][29][30][31][32][33][34][35][36][37][38][39][100][101][102][103][104][105][106] All of the above studies estimated the reduction in adverse events using organ doses calculated based on a radiotherapy plan and a model for the relationship between organ doses and effects. PBT for childhood brain tumor, particularly medulloblastoma, was confirmed to have better cost-effectiveness due to reduced adverse events.…”