Economic Analysis of Radiation Therapy Oncology Group 97-14

Abstract

Introduction RTOG 97-14 concluded a single fraction of radiation was as effective in relieving pain as multiple fractions in the treatment of patients with bone metastases. A statistically significant higher re-treatment rate, however, was noted in patients undergoing a single fraction treatment. The purpose of the analysis was to determine if multiple fraction treatment is cost-effective in treating patients with bone metastasis by preventing further re-treatment. Methods & Material A Markov model was used to evaluate the cost-effectiveness of 30 Gy in 10 fractions compared to 8 Gy in 1 fraction. Transition probabilities, cost and utilities were obtained from the clinical trial. Costs and outcomes were not discounted because of the short-time line for the study. Results The expected mean cost and quality adjusted survival in months for patients receiving 8 Gy in 1 fraction and 30 Gy in 10 fractions was $998 and 7.26 months and $2,316 and 9.53 months, respectively. The incremental cost-effectiveness ratio (ICER) was $6973/quality-adjusted life year. The results were sensitive to the utility of the post-treatment state for both single and multiple fraction treatment. Conclusion Single fraction treatment was the less expensive treatment in the treatment of patients with bone metastasis treated on RTOG 97-14.

Single fraction radiotherapy versus multiple fraction radiotherapy for bone metastases in prostate cancer patients: comparative effectiveness

“…The costs of radiotherapy can differ between jurisdictions, but studies from three countries on three continents have consistently shown a cost-effectiveness advantage to SF regimens. 29 – 31 Healthcare costs should not play a disproportionate role in treatment decisions, but are still an important consideration, and favor SF regimens.…”

“…Various studies have reported on the economic advantage of SF over MF regimens. 10 , 29 – 32 In the Dutch Bone Metastasis Study the estimated cost of radiotherapy, including retreatments and nonmedical costs, was significantly lower for the SF regimen than for the MF regimen ($2,438 [US dollars] versus $3,311, P <0.001). 31 The saving of radiotherapy capacity was considered a major economic advantage of the SF regimen.…”

“…Konski et al published an analysis of the RTOG 9714 study using a Markov model to evaluate the cost-effectiveness of 30 Gy/10 F compared with 8 Gy/1 F. 29 The mean cost and quality-adjusted survival in months for the 8 Gy/1 F regimen were $998 (US dollars) and 7.26 months, and $2,316 (US dollars) and 9.53 months for the 30 Gy/10 F regimen. The incremental cost-effectiveness ratio was $6,973 US dollars/quality-adjusted life year, in favor of the SF regimen.…”

Continuous controversy about radiation oncologists’ choice of treatment regimens for bone metastases: should we blame doctors, cancer-related features, or design of previous clinical studies?

“…Recent guidelines appreciate the fact that any treatment recommendation must fit the individual need of a given patient, and that we have to choose appropriately from several fractionation options [42-44]. If there is a medical need for more intense radiotherapy despite of higher economic burden (an example of cost-effectiveness is given in [45]), any additional operating expense should also be reimbursed. For the purpose of this mini-review, we will not discuss the ability to deliver single fraction or hypofractionated stereotactic body radiotherapy to certain metastatic sites [46,47].…”

‘Who’, ‘when’ and ‘how’ in re-irradiation of recurrent painful bone metastases

“…Van-den Hout WB et al at Netherlands [7] did a cost utility analysis showing the cost of radiation treatment including re-treatment for bone metastases using SF versus MF were €2438 versus €3311 respectively. RTOG 9714 groups showed the expected mean cost was US $1009 and US $2322 for treating with 8 Gy/1 Fr and 30 Gy/10 Fr respectively [8] . It is evident that SF is more cost effective than MF treatment.…”