title: Using decision analysis to determine the cost-effectiveness of intensity-modulated radiation therapy in the treatment of intermediate risk prostate cancer.
abstract: BACKGROUND
  The specific aim of this study is to evaluate the cost-effectiveness of intensity-modulated radiation therapy (IMRT) compared with three-dimensional conformal radiation therapy (3D-CRT) in the treatment of a 70-year-old with intermediate-risk prostate cancer.
  
  
  METHODS
  A Markov model was designed with the following states; posttreatment, hormone therapy, chemotherapy, and death. Transition probabilities from one state to another were calculated from rates derived from the literature for IMRT and 3D-CRT. Utility values for each health state were obtained from preliminary studies of preferences conducted at Fox Chase Cancer Center. The analysis took a payer's perspective. Expected mean costs, cost-effectiveness scatterplots, and cost acceptability curves were calculated with commercially available software.
  
  
  RESULTS
  The expected mean cost of patients undergoing IMRT was $47,931 with a survival of 6.27 quality-adjusted life years (QALYs). The expected mean cost of patients having 3D-CRT was $21,865 with a survival of 5.62 QALYs. The incremental cost-effectiveness comparing IMRT with CRT was $40,101/QALYs. Cost-effectiveness acceptability curve analysis revealed a 55.1% probability of IMRT being cost-effective at a $50,000/QALY willingness to pay.
  
  
  CONCLUSIONS
  Intensity-modulated radiation therapy was found to be cost-effective, however, at the upper limits of acceptability. The results, however, are dependent on the assumptions of improved biochemical disease-free survival with fewer patients undergoing subsequent salvage therapy and improved quality of life after the treatment. In the absence of prospective randomized trials, decision analysis can help inform physicians and health policy experts on the cost-effectiveness of emerging technologies.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. andre.konski@fccc.edu
authors.forename: Andre
authors.initials: A
authors.lastname: Konski
authors.forename: Deborah
authors.initials: D
authors.lastname: Watkins-Bruner
authors.forename: Steven
authors.initials: S
authors.lastname: Feigenberg
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.forename: Sachin
authors.initials: S
authors.lastname: Kulkarni
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D020266:Radiotherapy, Conformal / Q000191:economics; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*
chemical_list: D000726:Androgen Antagonists