title: Two-year and lifetime cost-effectiveness of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for head-and-neck cancer.
abstract: OBJECTIVE
  To assess the cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3D-CRT) in the treatment of head-and neck-cancer (HNC).
  
  
  METHODS
  We used a Markov model to simulate radiation therapy-induced xerostomia and dysphagia in a hypothetical cohort of 65-year-old HNC patients. Model input parameters were derived from PARSPORT (CRUK/03/005) patient-level trial data and quality-of-life and Medicare cost data from published literature. We calculated average incremental cost-effectiveness ratios (ICERs) from the US health care perspective as cost per quality-adjusted life-year (QALY) gained and compared our ICERs with current cost-effectiveness standards whereby treatment comparators less than $50,000 per QALY gained are considered cost-effective.
  
  
  RESULTS
  In the first 2 years after initial treatment, IMRT is not cost-effective compared with 3D-CRT, given an average ICER of $101,100 per QALY gained. However, over 15 years (remaining lifetime on the basis of average life expectancy of a 65-year-old), IMRT is more cost-effective at $34,523 per QALY gained.
  
  
  CONCLUSIONS
  Although HNC patients receiving IMRT will likely experience reduced xerostomia and dysphagia symptoms, the small quality-of-life benefit associated with IMRT is not cost-effective in the short term but may be cost-effective over a patient's lifetime, assuming benefits persist over time and patients are healthy and likely to live for a sustained period. Additional data quantifying the long-term benefits of IMRT, however, are needed.
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Racquel E
authors.initials: RE
authors.lastname: Kohler
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Sheets
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.forename: Chris
authors.initials: C
authors.lastname: Nutting
authors.forename: Emma
authors.initials: E
authors.lastname: Hall
authors.forename: Bhishamjit S
authors.initials: BS
authors.lastname: Chera
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D006258:Head and Neck Neoplasms / Q000191:economics / Q000532:radiotherapy*; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D006278:Medicare / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000191:economics*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000191:economics*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D014987:Xerostomia / Q000209:etiology / Q000517:prevention & control*