Cost Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared with Radiofrequency Ablation for Inoperable Colorectal Liver Metastases
Menée à partir d'un modèle mathématique incorporant des données de la littérature scientifique et des données de remboursement de l'assurance maladie Medicare pour l'année 2014, cette étude compare le rapport coût-efficacité d'une radiothérapie stéréotaxique et d'une ablation par radiofréquence chez les patients présentant des métastases hépatiques inopérables ayant pour origine un cancer colorectal
Purpose : Stereotactic body radiation therapy (SBRT) has shown promising results for local tumor control and survival for inoperable liver metastases resulting from colorectal cancer (CRC). However, SBRT can be expensive and resource intensive. Whether the benefits afforded by SBRT are cost effective compared to radiofrequency ablation (RFA) has not been previously studied.
Methods and Materials : A cost effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities and costs associated with SBRT and RFA were captured in the model based on a comprehensive literature review and on Medicare reimbursement in 2014. Strategies were compared using the incremental cost effectiveness ratio (ICER), with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained.
Results : In base case analysis, treatment costs for three fractions of SBRT and one RFA procedure were $13,000 and $4,397, respectively. Median survival was assumed same for both strategies (25 months). The SBRT costs $8,202 more than RFA while gaining 0.05 QALYs, resulting in an ICER of $164,660 per QALY gained. In one-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. SBRT was economically reasonable if better survival was presumed (> 1 month gain) or if used for large tumors (>4 cm).
Conclusion : If equal survival is assumed, SBRT is not cost effective compared to RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost effective. Ideally, these results should be confirmed with prospective comparative data.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2015