title: Cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for anal cancer.
abstract: OBJECTIVE
  To compare the cost-effectiveness of intensity modulated radiation therapy (IMRT) and 3-dimensional conformal radiation therapy (3D-CRT) for anal cancer and determine disease, patient, and treatment parameters that influence the result.
  
  
  METHODS
  A Markov decision model was designed with the various disease states for the base case of a 65-year-old patient with anal cancer treated with either IMRT or 3D-CRT and concurrent chemotherapy. Health states accounting for rates of local failure, colostomy failure, treatment breaks, patient prognosis, acute and late toxicities, and the utility of toxicities were informed by existing literature and analyzed with deterministic and probabilistic sensitivity analysis.
  
  
  RESULTS
  In the base case, mean costs and quality-adjusted life expectancy in years (QALY) for IMRT and 3D-CRT were $32,291 (4.81) and $28,444 (4.78), respectively, resulting in an incremental cost-effectiveness ratio of $128,233/QALY for IMRT compared with 3D-CRT. Probabilistic sensitivity analysis found that IMRT was cost-effective in 22%, 47%, and 65% of iterations at willingness-to-pay thresholds of $50,000, $100,000, and $150,000 per QALY, respectively.
  
  
  CONCLUSIONS
  In our base model, IMRT was a cost-ineffective strategy despite the reduced acute treatment toxicities and their associated costs of management. The model outcome was sensitive to variations in local and colostomy failure rates, as well as patient-reported utilities relating to acute toxicities.
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: joseph.hodges@utsouthwestern.edu.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Hodges
authors.affiliation: Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Beg
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Meyer
mesh_terms: D000368:Aged; D001005:Anus Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D003125:Colostomy; D003362:Cost-Benefit Analysis / Q000379:methods; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; 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; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D017211:Treatment Failure