title: Cost-effectiveness of stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer.
abstract: BACKGROUND
  The traditional treatment for clearly operable (CO) patients with stage I non-small cell lung cancer (NSCLC) is lobectomy, with wedge resection (WR) and stereotactic body radiation therapy (SBRT) serving as alternatives in marginally operable (MO) patients. Given an aging population with an increasing prevalence of screening, it is likely that progressively more people will be diagnosed with stage I NSCLC, and thus it is critical to compare the cost-effectiveness of these treatments.
  
  
  METHODS
  A Markov model was created to compare the cost-effectiveness of SBRT with WR and lobectomy for MO and CO patients, respectively. Disease, treatment, and toxicity data were extracted from the literature and varied in sensitivity analyses. A payer (Medicare) perspective was used.
  
  
  RESULTS
  In the base case, SBRT (MO cohort), SBRT (CO cohort), WR, and lobectomy were associated with mean cost and quality-adjusted life expectancies of $42,094/8.03, $40,107/8.21, $51,487/7.93, and $49,093/8.89, respectively. In MO patients, SBRT was the dominant and thus cost-effective strategy. This result was confirmed in most deterministic sensitivity analyses as well as probabilistic sensitivity analysis, in which SBRT was most likely cost-effective up to a willingness-to-pay of more than $500,000/quality-adjusted life year. For CO patients, lobectomy was the cost-effective treatment option in the base case (incremental cost-effectiveness ratio of $13,216/quality-adjusted life year) and in nearly every sensitivity analysis.
  
  
  CONCLUSIONS
  SBRT was nearly always the most cost-effective treatment strategy for MO patients with stage I NSCLC. In contrast, for patients with CO disease, lobectomy was the most cost-effective option.
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stetson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: Taine T V
authors.initials: TT
authors.lastname: Pechet
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics*; D012107:Research Design; D012680:Sensitivity and Specificity
keywords: cost-effectiveness; lobectomy; lung cancer; stereotactic body radiation therapy; surgery; wedge resection