title: Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer.
abstract: BACKGROUND
  Radiotherapy may improve the outcome of patients with pancreatic cancer but at an increased cost. In this study, the authors evaluated the cost-effectiveness of modern radiotherapy techniques in the treatment of locally advanced pancreatic cancer.
  
  
  METHODS
  A Markov decision-analytic model was constructed to compare the cost-effectiveness of 4 treatment regimens: gemcitabine alone, gemcitabine plus conventional radiotherapy, gemcitabine plus intensity-modulated radiotherapy (IMRT); and gemcitabine with stereotactic body radiotherapy (SBRT). Patients transitioned between the following 5 health states: stable disease, local progression, distant failure, local and distant failure, and death. Health utility tolls were assessed for radiotherapy and chemotherapy treatments and for radiation toxicity.
  
  
  RESULTS
  SBRT increased life expectancy by 0.20 quality-adjusted life years (QALY) at an increased cost of $13,700 compared with gemcitabine alone (incremental cost-effectiveness ratio [ICER] = $69,500 per QALY). SBRT was more effective and less costly than conventional radiotherapy and IMRT. An analysis that excluded SBRT demonstrated that conventional radiotherapy had an ICER of $126,800 per QALY compared with gemcitabine alone, and IMRT had an ICER of $1,584,100 per QALY compared with conventional radiotherapy. A probabilistic sensitivity analysis demonstrated that the probability of cost-effectiveness at a willingness to pay of $50,000 per QALY was 78% for gemcitabine alone, 21% for SBRT, 1.4% for conventional radiotherapy, and 0.01% for IMRT. At a willingness to pay of $200,000 per QALY, the probability of cost-effectiveness was 73% for SBRT, 20% for conventional radiotherapy, 7% for gemcitabine alone, and 0.7% for IMRT.
  
  
  CONCLUSIONS
  The current results indicated that IMRT in locally advanced pancreatic cancer exceeds what society considers cost-effective. In contrast, combining gemcitabine with SBRT increased clinical effectiveness beyond that of gemcitabine alone at a cost potentially acceptable by today's standards.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847, USA. jdmurphy@stanford.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
authors.forename: Jon
authors.initials: J
authors.lastname: Abelson
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
authors.forename: Heidi N
authors.initials: HN
authors.lastname: Yeung
authors.forename: Lorene M
authors.initials: LM
authors.lastname: Nelson
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics*; D011878:Radiotherapy / Q000191:economics*; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine