title: Outcome impact and cost-effectiveness of quality assurance for radiotherapy planned for the EORTC 22071-24071 prospective study for head and neck cancer.
abstract: BACKGROUND
  One of the goals of Quality Assurance in Radiotherapy (QART) is to reduce the variability and uncertainties related to treatment planning and beam delivery. The purpose of this study was to assess the outcome impact and cost-effectiveness (CE) of various QART levels for a head and neck (H&N) cancer study.
  
  
  METHODS
  QART levels were defined as: basic QART with a dummy run (level 2), level 2 plus prospective Individual Case Reviews (ICRs) for 15% of patients (level 3) and level 2 plus prospective ICRs for all patients (level 4). The follow-up of patients was modeled using a multi-state model with parameters derived from EORTC, TROG and RTOG prospective studies. Individual patient data, linking QART results with outcome, were retrieved from the TROG database. Results for each QART level were expressed as percentage of mortality and local failure at 5 years.
  
  
  RESULTS
  Quality-of-life-adjusted and recurrence-free survival increased with increasing QART levels. The increase of all these metrics was more sizeable with an increased QART level from 2 or 3 to 4. The estimated quality-adjusted-life-years (QALYs) for an increase of QART levels of 3-4 and 2-4 were 0.09 and 0.15, respectively. The incremental CE ratio was €5525 and €3659 Euros per QALY for these QART levels. Compared to QART level 2 or 3, level 4 was cost-effective.
  
  
  CONCLUSIONS
  Increasing QART levels resulted in better patient outcome in this simulated study. The increased complexity of the QART program was also cost-effective.
authors.affiliation: Center for Proton Therapy, Paul Scherrer Institute, Switzerland; QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium. Electronic address: damien.weber@psi.ch.
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.affiliation: QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium; Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: coen.hurkmans@catharinaziekenhuis.nl.
authors.forename: Coen W
authors.initials: CW
authors.lastname: Hurkmans
authors.affiliation: QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium. Electronic address: christos.melidis@eortc.be.
authors.forename: Christos
authors.initials: C
authors.lastname: Melidis
authors.affiliation: Heinrich-Heine Universitätsklinik Düsseldorf, Germany. Electronic address: Wilfried.Budach@med.uni-duesseldorf.de.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.affiliation: University Medical Center Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Langendijk
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia. Electronic address: Lester.Peters@petermac.org.
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Peters
authors.affiliation: St. Luc University Hospital, Brussels, Belgium. Electronic address: vincent.gregoire@imre.ucl.ac.be.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
authors.affiliation: Radiation Oncology, Centre Georges-François-Leclerc, Dijon, France. Electronic address: pmaingon@dijon.fnclcc.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.affiliation: Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, Switzerland. Electronic address: christophe.combescure@hcuge.ch.
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000532:radiotherapy*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006258:Head and Neck Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D006801:Humans; D015233:Models, Statistical; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019057:Quality-Adjusted Life Years; D011880:Radiotherapy Planning, Computer-Assisted / Q000191:economics* / Q000379:methods* / Q000592:standards; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
keywords: Cost-effectiveness; Head and neck cancer; Quality assurances; Quality-adjusted-life-years; Radiotherapy