The combined use of surgery and radiotherapy to treat patients with epidural cord compression due to metastatic disease: a cost-utility analysis

Abstract

Neoplastic metastatic epidural spinal cord compression is a common complication of cancer that causes pain and progressive neurologic impairment. The previous standard treatment for this condition involved corticosteroids and radiotherapy (RT). Direct decompressive surgery with postoperative radiotherapy (S + RT) is now increasingly being chosen by clinicians to significantly improve patients' ability to walk and reduce their need for opioid analgesics and corticosteroids. A cost-utility analysis was conducted to compare S + RT with RT alone based on the landmark randomized clinical trial by Patchell et al. (2005). It was performed from the perspective of the Ontario Ministry of Health and Long-Term Care. Ontario-based costs were adjusted to 2010 US dollars. S + RT is more costly but also more effective than corticosteroids and RT alone, with an incremental cost-effectiveness ratio of US$250 307 per quality-adjusted life year (QALY) gained. First order probabilistic sensitivity analysis revealed that the probability of S + RT being cost-effective is 18.11%. The cost-effectiveness acceptability curve showed that there is a 91.11% probability of S + RT being cost-effective over RT alone at a willingness-to-pay of US$1 683 000 per QALY. In practice, the results of our study indicate that, by adopting the S + RT strategy, there would still be a chance of 18.11% of not paying extra at a willingness-to-pay of US$50 000 per QALY. Those results are sensitive to the costs of hospice palliative care. Our results suggest that adopting a standard S + RT approach for patients with MSCC is likely to increase health care costs but would result in improved outcomes.

Adverse events in emergency oncological spine surgery: a prospective analysis

“…The societal costs of these AEs for this palliative intervention is also an important consideration. 6,18 The primary purpose of this study was to determine the true incidence of AEs in this specific population of patients undergoing emergency spine surgery for metastatic epidural spine disease and to compare the results of an AE-targeted prospective study to the best available literature. We hypothesized that AE rates would be higher when collected prospectively compared to retrospectively.…”

Intradural tumor recurrence after resection of extradural metastasis: a rare but potential complication of intraoperative durotomy

“…Spinal metastases, in particular, are very common in patients with metastatic cancer, and interventions to treat these lesions have the potential to significantly improve an individual's quality of life. 3,8,14,16,24 While the overall prognosis of patients with metastatic spinal tumors remains poor, advances in spinal instrumentation and stereotactic radiotherapy techniques have allowed higher rates of local tumor control, with lessened pain severity and improved neurological function. 16,24 Nevertheless, the goal of surgery remains palliative because patients' median survival following development of spinal metastases is typically 3-12 months, and tumor histology is one of the most significant factors predicting survival and determining treatment strategies.…”

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,…”

“…All studies included treatment and planning costs, per the objective of the studies. Only 33% of the studies incorporated institution or facility costs into their costing model, which most often included inpatient, outpatient, and technical costs of the hospital 7,16,18,22,24,26,[33][34][35][36][37] . Only five studies (15%) included equipment costs in their cost analyses (that is, computed tomography scanner and planning system, capital cost, specialized construction cost, and maintenance and operating costs of the radiation equipment) 22,24,34,35,37 .…”

“…Of the 437 remaining studies, 386 were removed because of lack of relevant content, and another 18 were removed because only abstracts were available (Figure 1). Of the thirty-three original articles included in the analysis, twenty-seven had been conducted in the United States (one of which used international data 26 ), four were from Canada [34][35][36][37] , and two were from the Netherlands 38,39 .…”