Cost-effectiveness Analysis of a Randomized Study... : American Journal of Clinical Oncology (original) (raw)

Original Articles: Central Nervous System

Cost-effectiveness Analysis of a Randomized Study Comparing Radiosurgery With Radiosurgery and Whole Brain Radiation Therapy in Patients With 1 to 3 Brain Metastases

Lincy S. Lal
Stacey DaCosta Byfield
Eric L. Chang
Luisa Franzini
Lesley-Ann Miller
Rebecca Arbuckle
Liezl Reasonda
Chun Feng
Andrea Adamus
John Michael Swint

American Journal of Clinical Oncology

(

)

February 2012

| DOI: 10.1097/COC.0b013e3182005a8f

Background

In this study, we compare 2 treatment options and determine cost-effectiveness and cost-utility.

Methods

We carried out a decision analysis populated with data from patients with brain metastasis in a concurrent trial randomized to either stereotactic radiosurgery (SRS) and observation or SRS and whole brain radiation therapy. Outcomes included actual life years saved (LYS), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Costs used were from the healthcare perspective and utilities were captured through a time-trade-off method, using 10-year, 5-year, and 1-year time horizons. One-way sensitivity analyses were carried out to determine robustness of the decision analysis model.

Results

Compared with SRS and whole brain radiation therapy, SRS and observation not only had a higher average cost ($74,000 vs 119,000,respectively)butalsoahigheraverageeffectiveness(0.60LYSvs1.64LYS,respectively)withanICERof119,000, respectively) but also a higher average effectiveness (0.60 LYS vs 1.64 LYS, respectively) with an ICER of 119,000,respectively)butalsoahigheraverageeffectiveness(0.60LYSvs1.64LYS,respectively)withanICERof44,231/LYS or 41,783/QALY(withutilitiescapturedusinga10−yearhorizon).SlightlyhigherICERestimateswereachievedwithutilitiescapturedusingtheothertimehorizons(41,783/QALY (with utilities captured using a 10-year horizon). Slightly higher ICER estimates were achieved with utilities captured using the other time horizons (41,783/QALY(withutilitiescapturedusinga10−yearhorizon).SlightlyhigherICERestimateswereachievedwithutilitiescapturedusingtheothertimehorizons(43,280/QALY and $44,064/QALY, respectively). Sensitivity analysis showed that the following variables had the highest impact on the ICER: probability of no recurrence in recursive-partitioning analysis class 2 after SRS and observation; probability of being alive after SRS and observation in recursive-partitioning analysis class 2 and being treated for recurrence.

Conclusions

Compared with other interventions in the 50,000to50,000 to 50,000to100,000/QALY cost-effectiveness range, the application of SRS and observation, with subsequent neurosurgical management of recurrences, is shown to be a reasonable treatment modality for brain metastases.