title: A comparison of surgical intervention and stereotactic body radiation therapy for stage I lung cancer in high-risk patients: a decision analysis.
abstract: OBJECTIVE
  We sought to compare the relative cost-effectiveness of surgical intervention and stereotactic body radiation therapy in high risk patients with clinical stage I lung cancer (non-small cell lung cancer).
  
  
  METHODS
  We compared patients chosen for surgical intervention or SBRT for clinical stage I non-small cell lung cancer. Propensity score matching was used to adjust estimated treatment hazard ratios for the confounding effects of age, comorbidity index, and clinical stage. We assumed that Medicare-allowable charges were $15,034 for surgical intervention and $13,964 for stereotactic body radiation therapy. The incremental cost-effectiveness ratio was estimated as the cost per life year gained over the patient's remaining lifetime by using a decision model.
  
  
  RESULTS
  Fifty-seven patients in each arm were selected by means of propensity score matching. Median survival with surgical intervention was 4.1 years, and 4-year survival was 51.4%. With stereotactic body radiation therapy, median survival was 2.9 years, and 4-year survival was 30.1%. Cause-specific survival was identical between the 2 groups, and the difference in overall survival was not statistically significant. For decision modeling, stereotactic body radiation therapy was estimated to have a mean expected survival of 2.94 years at a cost of $14,153 and mean expected survival with surgical intervention was 3.39 years at a cost of $17,629, for an incremental cost-effectiveness ratio of $7753.
  
  
  CONCLUSIONS
  In our analysis stereotactic body radiation therapy appears to be less costly than surgical intervention in high-risk patients with early stage non-small cell lung cancer. However, surgical intervention appears to meet the standards for cost-effectiveness because of a longer expected overall survival. Should this advantage not be confirmed in other studies, the cost-effectiveness decision would be likely to change. Prospective randomized studies are necessary to strengthen confidence in these results.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.forename: Traves D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: Steven
authors.initials: S
authors.lastname: Kymes
authors.forename: Martin
authors.initials: M
authors.lastname: Gregory
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bell
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bradley
authors.forename: Clifford
authors.initials: C
authors.lastname: Robinson
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Krupnick
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D008923:Missouri; D018803:Models, Economic; D009367:Neoplasm Staging; D018579:Patient Selection; D057216:Propensity Score; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States