Prophylactic cranial irradiation revisited: cost-effectiveness and quality of life in small-cell lung cancer.
OBJECTIVE
To investigate the therapeutic usefulness and cost-effectiveness of prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC) who had achieved a complete remission.


METHODS
A retrospective chart review was undertaken of all patients diagnosed in Saskatchewan with SCLC between 1987 and 1998 inclusive. Patients who achieved a complete remission were divided into two groups, depending on whether they underwent PCI (PCI+ and PCI-, respectively). The quality-of-life-adjusted survival was estimated by the Q-TWiST method (quality time without symptoms and toxicity). The mean incremental costs per month of incremental OS were calculated in a cost-effectiveness analysis.


RESULTS
Among the 98 complete remission patients, the median OS for PCI+ and PCI- patients was 20.0 and 19.0 months, respectively (p > 0.05, nonsignificant). The median disease-free survival was 14.7 and 10.0 months, respectively (p < 0.05). The difference in the mean Q-TWiST survival was significant (p < 0.01). The mean marginal cost was $18,834/PCI+ patient and $17,885/PCI- patient (p > 0.05, nonsignificant). The cost-effectiveness ratio was $70/mo of incremental OS if u(tox) and u(rel) (the utility coefficients to reflect the value of time in health states of toxicity and relapse) were assumed to be 1.0.


CONCLUSIONS
PCI is a cost-effective treatment that improves the quality-of-life-adjusted survival for patients with a complete remission of SCLC.
Tai
T H Patricia
TH
Department of Radiation Oncology, Allan Blair Cancer Center, Regina, Saskatchewan, Canada. ptai@scf.sk.ca
Yu
Edward
E
Dickof
Peter
P
Beck
Glen
G
Tonita
Jon
J
Ago
Tete
T
Skarsgard
David
D
Schmidt
Marlene
M
Schmid
Matthew
M
Liem
John S K
JS
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D016371:Cranial Irradiation / Q000191:economics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate