Economic analysis of radiation therapy oncology group 97-14: multiple versus single fraction radiation treatment of patients with bone metastases.
BACKGROUND
Radiation Therapy Oncology Group 97-14 concluded that a single fraction of radiation was as effective in relieving pain as multiple fractions in the treatment of patients with bone metastases. A statistically significant higher retreatment rate, however, was noted in patients undergoing a single fraction treatment. The purpose of the analysis was to determine whether multiple fraction treatment is cost-effective in treating patients with bone metastasis, by preventing further retreatment.


METHODS
A Markov model was used to evaluate the cost-effectiveness of 30 Gy in 10 fractions in comparison with 8 Gy in 1 fraction. Transition probabilities, cost, and utilities were obtained from the clinical trial. Costs and outcomes were not discounted because of the short time line for the study.


RESULTS
The expected mean cost and quality-adjusted survival in months for patients receiving 8 Gy in 1 fraction and 30 Gy in 10 fractions was 998 US dollars and 7.26 months and 2316 US dollars and 9.53 months, respectively. The incremental cost-effectiveness ratio was 6973 US dollars/quality-adjusted life year. The results were sensitive to the utility of the posttreatment state for both single and multiple fraction treatments.


CONCLUSIONS
Single fraction treatment was the less expensive treatment in the treatment of patients with bone metastasis treated on Radiation Therapy Oncology Group 97-14.
Konski
Andre
A
Department of Radiation Oncology, Wayne State University School of Medicine, Barbara Ann Karmanus Cancer Center, Detroit, MI 48201, USA. akonski@med.wayne.edu
James
Jennifer
J
Hartsell
William
W
Leibenhaut
Mark H
MH
Janjan
Nora
N
Curran
Walter
W
Roach
Mack
M
Watkins-Bruner
Deborah
D
D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019583:Dose Fractionation, Radiation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D010147:Pain Measurement; D010166:Palliative Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018787:Radiation Oncology / Q000191:economics* / Q000379:methods; D011878:Radiotherapy / Q000191:economics* / Q000379:methods; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States