title: Cost-effectiveness analysis comparing conventional versus stereotactic body radiotherapy for surgically ineligible stage I non-small-cell lung cancer.
abstract: BACKGROUND
  In 25% to 35% of patients with early stage I non-small-cell lung cancer (NSCLC), surgery is not feasible, and external-beam radiation becomes their standard treatment. Conventionally fractionated radiotherapy (CFRT) is the traditional radiation treatment standard; however, stereotactic body radiotherapy (SBRT) is increasingly being adopted as an alternate radiation treatment. Our objective was to conduct a cost-effectiveness analysis, comparing SBRT with CFRT for stage I NSCLC in a public payer system.
  
  
  METHODS
  Consecutive patients were reviewed using 2010 Canadian dollars for direct medical costs from a public payer perspective. A subset of direct radiation treatment delivery costs, excluding physician billings and hospitalization, was also included. Health outcomes as life-years gained (LYGs) were computed using time-to-event methods. Sensitivity analyses identified critical factors influencing costs and benefits.
  
  
  RESULTS
  From January 2002 to June 2010, 168 patients (CFRT, n = 50; SBRT, n = 118) were included; median follow-up was 24 months. Mean overall survival was 2.83 years (95% CI, 1.8 to 4.1) for CFRT and 3.86 years (95% CI, 3.2 to not reached) for SBRT (P = .06). Mean costs for CFRT were $6,886 overall and $5,989 for radiation treatment delivery only versus $8,042 and $6,962, respectively, for SBRT. Incremental costs (incremental cost-effectiveness ratio [ICER]) per LYG for SBRT versus CFRT were $1,120 for the public payer and $942 for radiation treatment alone. Varying survival and labor costs individually (± 20%) created the largest changes in the ICER, and simultaneous adjustment (± 5% to ± 30%) confirmed cost effectiveness of SBRT.
  
  
  CONCLUSIONS
  Using a threshold of $50,000 per LYG, SBRT seems cost effective. Results require confirmation with randomized data.
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada gunita.mitera@utoronto.ca.
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Swaminath
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Rudoler
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Seereeram
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Meredith
authors.initials: M
authors.lastname: Giuliani
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Leighl
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Dobrow
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Terence
authors.initials: T
authors.lastname: Yung
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.affiliation: University of Toronto; Princess Margaret Hospital; and Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hope
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging