title: A model of the cost-effectiveness of intensity-modulated radiotherapy in comparison with three-dimensional conformal radiotherapy for the treatment of localised prostate cancer.
abstract: OBJECTIVE
  To determine the cost-effectiveness of intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3DCRT) for men with localised prostate cancer from a UK National Health Service perspective.
  
  
  METHODS
  A discrete event simulation model was developed to simulate the progress of patients through advancing disease states until death from prostate cancer or other causes. Clinical effectiveness data for IMRT and 3DCRT were derived from a systematic review. Four scenarios were modelled based on different clinical studies. A probabilistic sensitivity analysis was undertaken and the incremental cost per quality adjusted life years (ICER) calculated.
  
  
  RESULTS
  In scenarios where estimated survival was greater for IMRT than 3DCRT, IMRT was clearly cost-effective (ICER <£20 000). For scenarios where only a difference in late gastrointestinal toxicity was assumed, the ICER was highly sensitive to uncertain model parameters, including the magnitude of the difference, the duration of gastrointestinal toxicity and the cost difference between treatments. For the most likely scenario, a 15% difference in late gastrointestinal toxicity, the ICER was £35 000, with a 20% probability that it is cost-effective at a maximum threshold of £20 000 and a 48% probability at a threshold of £30 000.
  
  
  CONCLUSIONS
  If IMRT can be used to prolong survival, it is very cost-effective. Otherwise cost-effectiveness is uncertain.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. s.hummel@sheffield.ac.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Hummel
authors.forename: M D
authors.initials: MD
authors.lastname: Stevenson
authors.forename: E L
authors.initials: EL
authors.lastname: Simpson
authors.forename: J
authors.initials: J
authors.lastname: Staffurth
mesh_terms: D003362:Cost-Benefit Analysis; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D018803:Models, Economic; D011471:Prostatic Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*