title: Cost-effectiveness analysis of a randomized study comparing radiosurgery with radiosurgery and whole brain radiation therapy in patients with 1 to 3 brain metastases.
abstract: 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) but also a higher average effectiveness (0.60 LYS vs 1.64 LYS, respectively) with an ICER of $44,231/LYS or $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 ($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 $50,000 to $100,000/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.
authors.affiliation: Ingenix Consulting-Healthcare, Missouri City, TX, USA. lincy.lal@ingenixconsulting.com
authors.forename: Lincy S
authors.initials: LS
authors.lastname: Lal
authors.forename: Stacey DaCosta
authors.initials: SD
authors.lastname: Byfield
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
authors.forename: Lesley-Ann
authors.initials: LA
authors.lastname: Miller
authors.forename: Rebecca
authors.initials: R
authors.lastname: Arbuckle
authors.forename: Liezl
authors.initials: L
authors.lastname: Reasonda
authors.forename: Chun
authors.initials: C
authors.lastname: Feng
authors.forename: Andrea
authors.initials: A
authors.lastname: Adamus
authors.forename: John Michael
authors.initials: JM
authors.lastname: Swint
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000191:economics / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D016371:Cranial Irradiation / Q000191:economics*; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics*; D013781:Texas