Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients.
BACKGROUND
Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non -small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients.


METHODS
A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRT) or higher (HRT) total treatment dose than CRT) and CRT.


RESULTS
All modified fractionations were more effective and costlier than CRT (1.12 QALYs, &OV0556;24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost &OV0556;25,746 and &OV0556;26,208, respectively. HRT and HRT yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost &OV0556;26,199 and &OV0556;29,683, respectively. MART had the highest NMB (&OV0556;79,322; 95% confidence interval [CI], &OV0556;35,478-&OV0556;133,648) and was the most cost-effective treatment followed by VART (&OV0556;78,347; 95% CI, &OV0556;64,635-&OV0556;92,526). CRT had an NMB of &OV0556;65,125 (95% CI, &OV0556;54,663-&OV0556;75,537). MART had the highest probability of being cost effective (43%), followed by VART (31%), HRT (24%), HRT (2%), and CRT (0%).


CONCLUSIONS
Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.
*Department of Health Services Research, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; †Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands; ‡Service Biostatistique et Epidémiologie, and §Département d'Oncologie et de Radiothérapie, Gustave Roussy, Villejuif, France; ‖Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; ¶Department of Radiation Oncology, University Hospital Leuven/KU Leuven, Leuven, Belgium; #List of the members of Meta-Analysis of Radiotherapy in Lung Cancer Collaborative Group is given at the end of the acknowledgments; and **Department of Epidemiology, Biostatistics and HTA, University Medical Center, St. Radboud, Nijmegen, The Netherlands. Institut Gustave-Roussy/Karolinska Institutet Radiation Therapy Oncology Group Peter MacCallum Cancer Centre and the University of Melbourne University of Dresden Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Penn State Hershey Cancer Institute Peter MacCallum Cancer Centre Victorian Comprehensive Cancer Centre University of Alabama-Birmingham The University of Texas Southwestern Dana-Farber Cancer Institute University Hospital Leuven and University Hospital Maastricht Mount Vernon Hospital Institut de Cancérologie de la Loire University of Dresden Institut Gustave-Roussy Mayo Clinic Institut Gustave-Roussy Centre Hospitalier Lyon Sud MRC Clinical Trials Unit Mayo Clinic MRC Clinical Trials Unit Radiation Therapy Oncology Group Institut Gustave-Roussy Mount Vernon Hospital Intermountain Medical Center Mayo Clinic Sinai Grace Hospital Maria Sklodowska -Curie Memorial Cancer Center and Institute of Oncology.
Bram L T
BL
Ramaekers
Manuela A
MA
Joore
Béranger
B
Lueza
Julia
J
Bonastre
Audrey
A
Mauguen
Jean-Pierre
JP
Pignon
Cecile
C
Le Pechoux
Dirk K M
DK
De Ruysscher
Janneke P C
JP
Grutters
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D003362:Cost-Benefit Analysis; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008390:Markov Chains; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate