Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy: An Emerging Initial Radiation Treatment Option for Organ-Confined Prostate Cancer

Abstract

Purpose: The purpose of this study is to compare the costeffectiveness of two external beam radiation therapy techniques for treatment of low-to intermediate-risk prostate cancer: stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT). Materials and Methods:A Markov decision analysis model with probabilistic sensitivity analysis was designed with the various disease states of a 70-year-old patient with organ-confined prostate cancer to evaluate the cost-effectiveness of two external beam radiation treatment options. Results:The Monte Carlo simulation revealed that the mean cost and quality-adjusted life-years (QALYs) for SBRT and IMRT were $22,152 and 7.9 years and $35,431 and 7.9 years, respectively. The sensitivity analysis revealed that if the SBRT cohort experienced a decrease in quality of life of 4% or a decrease in efficacy of 6%, then SBRT would no longer dominate IMRT in cost-effectiveness. In fact, with these relaxed assumptions for SBRT, the incremental cost-effectiveness ratio of IMRT met the societal willingness to pay threshold of $50,000 per QALY. Conclusion:Compared with IMRT, SBRT for low-to intermediate-risk prostate cancer has great potential cost savings for our health care system payers and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model suggests that the incremental cost-effectiveness ratio of IMRT compared with SBRT is highly sensitive to quality-of-life outcomes, which should be adequately and comparably measured in current and future prostate SBRT studies.

Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer

“…Findings from studies on efficacy and toxicity are summarised in Tables I and II. Treatment cost effectiveness. Two studies were identified that compared estimated mean costs of SBRT and CF-EBRT for early-stage prostate cancer (33,34). Results from both studies support the hypothesis that SBRT is associated with a smaller economic burden for patients and departments compared to CF-EBRT.…”

“…Results from both studies support the hypothesis that SBRT is associated with a smaller economic burden for patients and departments compared to CF-EBRT. One study estimated the mean cost of SBRT treatment for patients with early-stage prostate cancer to be $22,152 compared to $35,431 for CF-EBRT (33). The other study estimated a mean lifetime cost of $24,873 for patients treated with SBRT compared to $33,068 for CF-EBRT (34).…”

Radiation Costing Methods: A Systematic Review

“…The disease site most often evaluated in rt costing studies was prostate cancer (39%) 7,9,10,[15][16][17][18]24,27,29,31,32,34 , followed by breast cancer (18%) 8,19,22,25,26,28 , non-smallcell lung cancer (12%) 20,23,37,39 , head-and-neck cancer (9%) 14,33,38 , cervical cancer (6%) 13,21 , and other sites [bone metastases (6%) 12,30 , metastatic epidural spinal cord (3%) 36 , oropharyngeal cancer (3%) 35 , and squamous cell cancer of the anus (3%) 11 ]. Thirteen studies used original costing data to conduct the costing analysis 8,19,20,[24][25][26]28,[29][30][31][32][33]37 ; the remaining twenty studies modelled outcomes using hypothetical patient cohorts 7,…”

“…As shown in Figure 2, twenty-two studies provided costs for imrt 7,[9][10][11]14,[16][17][18][19][20][21][22][23][24]27,28,29,[31][32][33][34][35] ; sixteen, for 3D-c rt 11,14,15,17,19,20,22,23,28,[31][32][33][34][35]37,39 ; six, for bt 9,13,22,24,31,32 ; and six, for sbrt 7,10,20,23,27,37 . A number of studies also costed other modalities of rt (rt in general, whole-breast radiation, external-beam partial-breast irradiation, etc.…”

Challenges in the Analysis of Outcomes for Surgical Compared to Radiotherapy Treatment of Prostate Cancer

“…Prior studies have investigated the cost-effectiveness of various prostate cancer treatment modalities. Many of these studies have made comparisons among radiotherapy techniques, including brachytherapy and various radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and 3D-conformal radiotherapy (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Other studies have focused on comparisons among surgical techniques (28)(29)(30).…”